Beck’s Anxiety Questionnaire Please fill in your details and your results will be emailed to you. Please enable JavaScript in your browser to complete this form. - Step 1 of 3On the next page is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by the symptom during the past month, including today, by clicking the checkbox.NextNumber of tingling *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFeeling hot *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotWobbliness in legs *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotUnable to relax *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFear of worst happening *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotDizzy or lightheaded *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotHeart pounding / racing *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotUnsteady *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotTerrified or afraid *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotNervous *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFeeling of chocking *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotHands trembling *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotShaky / unsteady *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFear of losing control *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotDifficulty in breathing *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFear of dying *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotScared *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotIndigestion *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFaint / lightheaded *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotFace flushed *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotHot / cold sweats *Not at allMildly, but it didn't bother me muchModerately - it wasn't pleasant at timesSeverely - it bothered me a lotPreviousNextFull Name *FirstLastEmail *Here is your score:0Submit40300