\ Health Questionnaire Aanxiety Screening Test

The Patient Health Questionnaire
Aanxiety Screening Test

Health Questionnaire

Use this test to assess if you might be suffering from a anxiety problem or panic disorder

1. Pounding heart

Usually	Often	Sometimes	Rarely

2. Sweating

Usually	Often	Sometimes	Rarely

3. Trembling or shaking

Usually	Often	Sometimes	Rarely

4. Shortness of breath

Usually	Often	Sometimes	Rarely

5. Afraid or scared

Usually	Often	Sometimes	Rarely

6. Chest pain or discomfort

Usually	Often	Sometimes	Rarely

7. Nausea or abdominal distress

Usually	Often	Sometimes	Rarely

8. Feeling dizzy or unsteady

Usually	Often	Sometimes	Rarely

9. Fear of losing control or going crazy

Usually	Often	Sometimes	Rarely

10. Numbness or tingling sensations

Usually	Often	Sometimes	Rarely

11. Chills or hot flashes

Usually	Often	Sometimes	Rarely

12. Fear of dying

Usually	Often	Sometimes	Rarely

13. Constant or persistent worry

Usually	Often	Sometimes	Rarely

14. Feeling of choking

Usually	Often	Sometimes	Rarely

15. Unable to relax

Usually	Often	Sometimes	Rarely

16. Feeling of being unreal

Usually	Often	Sometimes	Rarely

17. Nervous

Usually	Often	Sometimes	Rarely

18. Feeling shaky or wobbly

Usually	Often	Sometimes	Rarely

19. Irritable or difficulty sleeping

Usually	Often	Sometimes	Rarely

20. Trembling hands

Usually	Often	Sometimes	Rarely

21. Avoid situations because of anxiety

Usually	Often	Sometimes	Rarely

22. Feeling lightheaded or faint

Usually	Often	Sometimes	Rarely

Contact Information

Full Name

E-Mail

Contact Number

The Patient Health Questionnaire Aanxiety Screening Test

Health Questionnaire

Contact Information

The Patient Health Questionnaire
Aanxiety Screening Test