Anxiety Screening – Intel Counselling

Name

Phone

Q1. Over the last 2 weeks, how often have you been bothered by: Feeling nervous, anxious, or on edge?Not at allSeveral daysMore than half the daysNearly every day

2. Not being able to stop or control worrying?Not at allSeveral daysMore than half the daysNearly every day

3. Worrying too much about different things?Not at allSeveral daysMore than half the daysNearly every day

4. Trouble relaxing?Not at allSeveral daysMore than half the daysNearly every day

5. Being so restless that it is hard to sit still?Not at allSeveral daysMore than half the daysNearly every day

6. Becoming easily annoyed or irritable?Not at allSeveral daysMore than half the daysNearly every day

7. Feeling afraid, as if something awful might happen?Not at allSeveral daysMore than half the daysNearly every day

Calculations