Anxiety Screener Form

Over the last 2 weeks, how often have you been bothered by the following problems?

Name

Email

Phone

Feeling nervous, anxious, or on edge

Not being able to stop or control worrying

Worrying too much about different things

Trouble relaxing

Being so restless that it is hard to sit still

Becoming easily annoyed or irritable

Feeling afraid as if something awful might happen

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