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Anxiety Evaluation Form

An anxiety evaluation form is a form that is used to evaluate a person's level of anxiety. It is a form that is used to help determine if a person has an anxiety disorder and to what extent.

3 minutes to complete

Eligibility

To fill out the anxiety evaluation form, one must be above the age of 18 years and have a willingness to participate in a research study.

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Questions for Anxiety Evaluation Form

Questions

1.

Full Name

The answer should be a text input.
2.

What is your age?

The answer should be a text input.
3.

What is your gender?

The answer should be a text input.
4.

Phone Number

The answer should be a phone number.
5.

Do you feel like you have control over your anxiety?

The answer should be a text input.
6.

Do you feel like your anxiety is impacting your relationships?

The answer should be a text input.
7.

What, if anything, do you do to cope with your anxiety?

The answer should be a text input.
8.

How long have you been experiencing anxiety?

The answer should be a text input.
9.

What are your main anxiety symptoms?

The answer should be a text input.
10.

Do you feel anxious in any specific situations or when confronted with certain objects or people?

The answer should be a text input.
11.

Do you avoid any situations or activities due to your anxiety?

The answer should be a text input.
12.

Do you feel that your anxiety is impacting your quality of life in any way?

The answer should be a text input.
13.

Do you feel that your anxiety is interfering with your work or school performance?

The answer should be a text input.
14.

Are you having any physical symptoms related to your anxiety, such as chest pain, racing heart, or difficulty breathing?

The answer should be a text input.
15.

Do you feel like you are in danger of harming yourself or others due to your anxiety?

The answer should be a text input.
16.

Do you have any other mental health conditions, such as depression, PTSD, or OCD?

The answer should be a text input.
17.

Are you interested in seeking professional help for your anxiety?

The answer should be a single choice:
  1. Yes
  2. No

Forms Similar to Anxiety Evaluation Form

  • Anxiety Disorder Evaluation Form
  • Anxiety Disorder Screening Form
  • Anxiety Disorder Symptom Checklist
  • Anxiety Disorder Treatment Plan
  • Anxiety Management Plan
  • Anxiety Reduction Plan
  • Anxiety Self-Assessment
  • Anxiety Symptom Scale

Here are some FAQs and additional information
on
Anxiety Evaluation Form

What is an anxiety evaluation form?

An anxiety evaluation form is a document that is used to assess an individual's anxiety level. It is typically completed by a mental health professional, such as a psychiatrist, psychologist, or counselor. The form usually includes questions about the frequency and severity of symptoms, as well as how the individual copes with anxiety.

How do you get an anxiety evaluation?

You may need to see a mental health specialist if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health professionals can diagnose anxiety and provide counseling (psychotherapy).

What information is typically included on an anxiety evaluation form?

An anxiety evaluation form typically includes questions about the frequency and severity of anxiety symptoms, as well as how the individual copes with anxiety. It may also include questions about the individual's medical history and family history of anxiety disorders.

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