My Anxiety Levels

Self Assessment - Anxiety

Feeling Anxious?

Check your anxiety levels by filling this form.

Undergoing anxiety disorders treatment?

Assess your outcomes by filling this form before starting your treatment and then at every 4 weeks during the treatment to know how you are doing with the treatment.

You can also fill this form, twice a year, just to keep a check!

Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by ticking the option under each symptom.

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Name
Name
First
Last
During past one month, how much the numbness and tingling bothered you?
During past one month, how much the wobbliness in legs bothered you?
How much you were bothered by hot feeling during the past one month?
During past one month how much were you bothered by being unable to relax?
How much were you bothered by fear of worst happening in the past one month?
How much were you bothered by feeling of dizziness or light headedness in the past one month?
How much were you bothered by heart pounding or racing feeling in the past one month?
How much were you bothered by feeling of unsteadiness in the past one month?
How much were you terrified or afraid in the past one month?
How much were you bothered by nervousness in the past one month?
How much were you bothered by feeling of choking in the past one month?
How much were you bothered by trembling hands in the past one month?
How much were you shaky in the past one month?
How much were you bothered by fear of losing control in the past one month?
How much were you bothered by difficulty in breathing in the past one month?
How much were you bothered by fear of dying in the past one month?
How much were you scared in the past one month?
How much were you bothered by indigestion in the past one month?
How much were you bothered by fainting in the past one month?
How much were you bothered by hot or cold sweat in the past one month?
How much were you bothered by flushed face in the past one month?
Are you taking any medication for this issue?
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