[form] The ANXIETY Inventory Name[text,name,30] Email [text,email,30] Choose a number for each item on the inventory that best describes how much you have experienced each symptom over the past week 1. Feeling Nervous [list,1. Feeling Nervous ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 2. Frequent worrying [list,2. Frequent worrying ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 3. Trembling, twitching, feeling shaky [list,3. Trembling, twitching, feeling shaky ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 4. Muscle tension, muscle aches, muscle soreness [list,4. Muscle tension, muscle aches, muscle soreness ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 5. Restlessness [list,5. Restlessness ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 6. Easily tired [list,6. Easily tired ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 7. Shortness of breath [list,7. Shortness of breath ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 8. Rapid heartbeat [list,8. Rapid heartbeat ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 9. Sweating not due to the heat [list,9. Sweating not due to the heat ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 10. Dry mouth [list,10. Dry mouth ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 11. Dizziness or light-headedness [list,11. Dizziness or light-headedness ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 12. Nausea, diarrhea, or stomach problems [list,12. Nausea, diarrhea, or stomach problems ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 13. Frequent urination [list,13. Frequent urination ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 14. Flushes (hot flashes) or chills [list,14. Flushes (hot flashes) or chills ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 15. Trouble swallowing or "lump in the throat" [list,15. Trouble swallowing or "lump in the throat" ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 16. Feeling keyed up or on edge [list,16. Feeling keyed up or on edge ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 17. Quick to startle [list,17. Quick to startle ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 18. Difficulty concentrating [list,18. Difficulty concentrating ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 19. Trouble falling or staying asleep [list,19. Trouble falling or staying asleep ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 20. Irritability [list,20. Irritability ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 21. Avoiding places where I might be anxious [list,21. Avoiding places where I might be anxious] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 22. Frequent thoughts of danger [list,22. Frequent thoughts of danger ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 23. Seeing myself as unable to cope [list,23. Seeing myself as unable to cope ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] 24. Frequent thoughts that something terrible with happen [list,24. Frequent thoughts that something terrible with happen ] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Sometimes] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] What is the total of all your selections? [text,score,10] [submit,SEND this Entry][reset,Start Over again] [/form]