Beck Anxiety Inventory
The following assessment is used measure your symptoms over the course of several weeks. You are encouraged to complete this form every two months and talk about any concerns at your next session. 

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Email *
Client Name *
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Numbness or tingling
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Feeling hot
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Wobbliness in legs
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Unable to relax
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Fear of worst happening
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Dizzy or lightheaded
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Heart pounding / racing
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Unsteady
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Terrified or afraid
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Nervous
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Feeling of choking
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Hands trembling
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Fear of losing control
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Shaky / Unsteady
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Difficulty in breathing
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Fear of dying
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Scared
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Indigestion
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Faint / lightheaded
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Face flushed
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
Hot / cold sweats
Your Answer
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Clear selection
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