3 minutes
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.
Full Name
What is your age?
What is your gender?
Phone Number
Do you feel like you have control over your anxiety?
Do you feel like your anxiety is impacting your relationships?
What, if anything, do you do to cope with your anxiety?
How long have you been experiencing anxiety?
What are your main anxiety symptoms?
Do you feel anxious in any specific situations or when confronted with certain objects or people?
Do you avoid any situations or activities due to your anxiety?
Do you feel that your anxiety is impacting your quality of life in any way?
Do you feel that your anxiety is interfering with your work or school performance?
Are you having any physical symptoms related to your anxiety, such as chest pain, racing heart, or difficulty breathing?
Do you feel like you are in danger of harming yourself or others due to your anxiety?
Do you have any other mental health conditions, such as depression, PTSD, or OCD?
Are you interested in seeking professional help for your anxiety?