Check Your Restless Thoughts

First Name

Last Name *

Date of birth *

Address

Street Address

City

State

Country

Postal Code

Email *

Phone *

1 I feel tense, restless, or unable to relax.

ANX-01 *

NeverAlways

2 I experience a racing heartbeat or palpitations.

ANX-02 *

NeverAlways

3 I have trouble sleeping because of worry or tension.

ANX-03 *

NeverAlways

4 I find it hard to stop or control worrying.

ANX-04 *

NeverAlways

5 I have difficulty concentrating because of anxious thoughts.

ANX-05 *

NeverAlways

6 I worry excessively about different things.

ANX-06 *

NeverAlways

7 I often feel nervous or on edge.

ANX-07 *

NeverAlways

8 I feel a sense of dread or impending danger.

ANX-08 *

NeverAlways

9 I feel easily overwhelmed, even by small tasks.

ANX-09 *

NeverAlways

10 I avoid situations that make me anxious.

ANX-10 *

NeverAlways

11 I seek reassurance repeatedly from others.

ANX-11 *

NeverAlways

12 I procrastinate or delay tasks because of worry.

ANX-12 *

Never AlwaysGood

Your Score

Total score from questionnaire

ANX-T