Anxiety Assessment

1. Anxiety, nervousness, worry or fear

2. That things around you are strange, unreal or foggy

3. Detached from all or part of your body

4. Sudden, unexpected panic spells

5. Apprehension or a sense of impending doom

6. Tense, stressed, "uptight" or on edge

7. Difficulty Concentrating

8. Racing thoughts

9. Frightening fantasies or daydreams

10. That you're on the verge of losing control

11. Fears of cracking up or going crazy

12. Fears of fainting or passing out

13. Fears of physical illness or heart attacks or dying

14. Concerns about looking foolish or inadequate in front of others

15. Fears of being alone, isolated or abandoned

16. Fears of criticism or disapproval

17. Fears that something terrible is about to happen

18. Skipping or racing or pounding of the heart

19. Pain, pressure or tightness in the chest

20. Tingling or numbness in the toes or fingers

21. Butterflies or discomfort in the stomach

22. Constipation or diarrhea

23. Restlessness or jumpiness

24. Tight, tense muscles

25. Sweating not brought on by heat

26. A lump in the throat

27. Trembling or shaking

28. Rubbery or "jelly" legs

29. Dizzy, light-headed or off balance

30. Choking or smothering sensations or difficulty breathing

31. Headaches or pains in the neck or back

32. Hot flashes or cold chills

33. Tired, weak or easily exhausted

All forms are now managed by our HIPAA-Compliant Office Servers.
Please contact us via Text or Call at 925-837-1100.

Patient Success Stories

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Jason J.
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