**Disclaimer: This is not a medical diagnosis.**
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Question of
Do you have racing thoughts in the morning?
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Yes
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No
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Question of
Do you get nervous in big crowds?
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Yes
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No
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Question of
Does your heart pound where you can feel in coming out of your chest?
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Yes
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No
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Question of
When you feel anxious do you sweat a lot?
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Yes
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No
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Question of
When you get anxious do you shake uncontrollably?
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Yes
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No
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Question of
When you get anxious do you feel like you can’t breathe?
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Yes
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No
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Question of
Are you a nervous person?
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Yes
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No
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Question of
Are you scared of what may happen if you go on a freeway?
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Yes
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No
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Question of
Do you avoid large crowds like a mall?
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Yes
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No
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Question of
Does being in a crowded place give you anxiety?
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Yes
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No
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Question of
Have you ever thought of seeing a doctor for anxiety?
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Yes
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No
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Question of
Do you have panic attacks?
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Yes
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No
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Question of
Do you have panic attacks more than 5 times a week?
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Yes
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No
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Question of
Do you have panic attacks more than 3 times a week?
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Yes
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No
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Question of
Do you find you are more anxious than your friends?
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Yes
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No
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Question of
Do you ever fear losing control?
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Yes
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No
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Question of
Do you feel like you’re going crazy?
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Yes
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No
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Question of
Do you feel numb or tingling sensations?
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Yes
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No
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Question of
Do you have the fear of dying?
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Yes
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No
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Question of
Do you have the feeling of choking?
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Yes
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No
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Question of
Do you worry more than 5 times per week?
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Yes
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No
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Question of
Do you worry more than 3 times per week?
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Yes
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No
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Question of
Do you feel like you can’t relax ever?
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Yes
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No
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Question of
Do you always feel nervous?
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Yes
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No
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Question of
Do you have difficulty sleeping?
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Yes
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No
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Question of
Do you avoid situations because of your anxiety?
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Yes
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No
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Question of
Do you speak openly about your anxiety because you’re ashamed?
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Yes
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No
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Question of
Do you avoid family or friends that make you anxious?
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Yes
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No
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Question of
Do you ever feel lightheaded?
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Yes
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No
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Question of
Do you feel strong anxiety everyday?
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Yes
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No
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