Generalized Anxiety
Assessment
Our Client Intake and Assessment Forms are designed to assist us in knowing more about you, your background, and what specific needs you wish to address. Any information received from these forms will be used for the expressed purpose of assisting you achieve your desired goals and is strictly confidential.
DEMOGRAPHIC ASSESSMENT
5. Explain your depression treatment history
6. Explain your bipolar disorder treatment history
7. Explain your generalized anxiety treatment history
8. Explain your post-traumatic disorder stress treatment history
4. Select your ethnicity/racial group:
3. What is your marital status?
2. What is your gender?
1. What is your age?
1. Most days I feel very nervous
GENERALIZED - ANXIETY DISORDER
The Generalized - Anxiety Disorder screening questions are presented below. Select one option for each question that comes closest to your answer.
These questions
are to ask things
you may
have felt most days
in the past six months:
3. Most days I cannot stop worrying
2. Most days I worry about lots of things
4. Most days my worry is hard to control
5. I feel restless, keyed up or on edge
6. I get tired easily
7. I have trouble concentrating
8. I am easily annoyed or irritated
9. My muscles are tense and tight
10. I have trouble sleeping
11. Did things you noted above affect your daily life (home-life, work, or leisure) or cause you a lot of distress?
12. Were the things you noted above bad enough that you thought about getting help for them?
13. Do you plan to seek further evaluation for generalized anxiety disorder?
Since people suffer from more than one disorder at the same time, or one can cause symptoms that seem like the other, you may want to take other screenings offered.
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