Anxiety Screening Test

Everybody worries or gets an occasional case of butterflies in the stomach. But are you missing out on opportunities and happiness because of fears and worries? Is anxiety interfering with your life? This Anxiety Screening Test is not intended to be a diagnostic tool but instead is meant to give you and I a better idea as to the extent of your anxiety.

For each statement below, please indicate how often you feel that way.

Rate your answers as follows:

  (1) Sometimes
(2) Often
(3) Never - or I don't know

1. I have trouble falling or staying asleep.
1 2 3
2. I worry about my health or dying.
1 2 3
3. I am able to relax.
1 2 3
4. When I get nervous, I have palpitations, pounding heart, or accelerated heart rate.
1 2 3
5. I have less interest in activities that I normally enjoyed.
1 2 3
6. I worry a lot.
1 2 3
7. I spend time wondering why I feel the way I do.
1 2 3
8. I am afraid of crowds, being left alone, the dark, of strangers, or of traffic.
1 2 3
9. I have headaches or neck pain.
1 2 3
10. Sometimes I feel fearful for no reason.
1 2 3
11. When someone snaps at me, I spend the rest of the day thinking about it.
1 2 3
12. I feel good about myself.
1 2 3
13. I feel I am losing control.
1 2 3
14. To me, the world is a scary place.
1 2 3
15. No matter what I do, I can’t get my mind off my problems.
1 2 3
16. I am easily alarmed, frightened, or surprised.
1 2 3
17. I am as happy as the people around me.
1 2 3
18. My muscles are tense, aching, or sore.
1 2 3
19. I experience shortness of breath or choking feelings.
1 2 3
20. I tend to focus on upsetting situations or events happening in my life.
1 2 3

Congratulations on completing this questionnaire. Enter your contact information below. I will contact you within the next day to discuss your results and the possibility of scheduling an appointment.

Name:

Telephone:

Email:











































Randi Fredricks, LMFT, CHT, RAS, CCN, CCH    ♦     1711 Hamilton Ave Suite A, San Jose, California, 95125     ♦     408-315-0645

Contact Randi Online

This site does not provide medical advice, diagnosis, or treatment and is intended for informational purposes only. No therapeutic relationship is established
by the use of this site. Randi Fredricks is a Psychotherapist and Licensed as a Marriage Family Therapist MFC 47803 and not licensed with the California
Medical Board or the Bureau of Naturopathic Medicine. © 2001-2010 Randi Fredricks. All rights reserved. Medical Disclaimer and Copyright