Anxiety Screening

Please read the questions below carefully and provide your best answer about how you have been feeling the past two weeks. Click each dropdown option to provide your answer. After completion, a Friends For All counselor will get in touch with you within 48 business hours. If you are experiencing a medical emergency, please call 911 immediately.

Name

First Name

Last Name

Phone

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Friends For All Counselor

I have been feeling nervous, anxious, or on edge.

I have been worrying too much about different things.

I have had trouble relaxing.

I have been so restless that it is hard to sit still.

I have been easily annoyed or irritable.

I have been feeling afraid, as if something awful might happen.

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?