Anxiety Quiz

Anxiety Assessment Quiz

"But God commendeth his love toward us, in that, while we were yet sinners, Christ died for us.”

- ROMANS 5:8

Questionnaire

* Indicates required field

Name *

First

Last

Those who suffer from chronic anxiety often complain about uncomfortable physical symptoms.

Check all that currently apply to you: *

Strong anxiety episodes Racing heart, palpitations, or 'flutters' Trembling Nausea Hot and cold flashes Feelings of unreality and disorientation Dizziness Scary, uncontrollable thoughts Depressed feelings Fatigue Feelings of helplessness Panic episodes Muscle tension Migraine headaches Numbness in various parts of the body Strange aches or pains

How many times per week do you have a panic attack? *

How much does this condition disrupt your life? *

Those suffering with anxiety often have extreme apprehensions.

Check all that currently apply to you: *

Dying Having a heart attack Fainting Losing their breath Going "insane" Losing control Embarrassing themselves Choking Hurting themselves Hurting others

People struggling with chronic anxiety have adopted certain personality traits.

Check all that currently apply to you: *

Perfectionist Inner nervousness Tendency to over-react much of the time Guilt ridden Extremely sensitive to criticism Emotionally sensitive Extremely high expectations Inability to make decisions Obsessive thinker Extremely analytical Suggestible to others problems Concerned with others opinions of you Tendency to worry about health problems Need to appear in control Low self-esteem

Limitations are certain things you cannot do as a result of your anxiety.

Check all that currently apply to you: *

Not being able to be alone comfortably Challenge driving alone or with someone Not being able to go shopping Uncomfortable socializing Not being able to make decisions Not being able to leave the house Not able to take elevators Not being able to be in enclosed spaces

List the event, situations, or opportunities that you have avoided in the last 3 months in order to avoid anxiety, panic, or feeling depressed? *

Those with anxiety have a common set of fears.

Check all that currently apply to you: *

Flying Socializing Driving or riding with others Speaking in front of people Standing in lines Being assertive Taking medications Traveling Working Any situation where you are not in control Eating Fear of doctors/hospitals Fear of illness Shopping Being alone Dying Leaving the house Thunderstorms Failure Crowded placed Not being able to get out or leave

Codependent tendencies can be present in those with chronic anxiety.

Check all that currently apply: *

Low self-esteem People pleasing tendencies Poor boundaries Reactivity Caretaking (verse caregiving) Controlling Perfectionism Dysfunctional communication Difficulty expressing needs Obsessiveness Painful emotions (can't process/let go) Addiction tendencies

Those who experience chronic anxiety tend to have a lot of negative self-talk.

Please list any repetitive negative self-talk that you tend to have: *

What bothers you the most about this condition? *

Submit

Contact Information
Stephanie Stanton, H.H.C.
Cell/Text: 201-892-3959
Email: stephmastro@gmail.com

Remote sessions available via Zoom or phone

Anxiety Assessment Quiz

- ROMANS 5:8

Questionnaire

​Those who suffer from chronic anxiety often complain about uncomfortable physical symptoms.

Those suffering with anxiety often have extreme apprehensions.

People struggling with chronic anxiety have adopted certain personality traits.

Limitations are certain things you cannot do as a result of your anxiety.

Those with anxiety have a common set of fears.

Codependent tendencies can be present in those with chronic anxiety.

Those who experience chronic anxiety tend to have a lot of negative self-talk.

Those who suffer from chronic anxiety often complain about uncomfortable physical symptoms.