Ingrid Oliansky, Licensed Marriage and Family Therapist
​MFC# 48975
Call for an appointment (818) 927-3855
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Anxiety Inventory
Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom in the past month, including today, by checking the appropriate box.
Name:
Date:

Anxiety, Nervousness, worry or fear
Feeling that things around you are strange or unreal
Feeling detached from all or part of your body
Sudden Unexpected Panic Spells
Apprehension or a sense of impending doom
Feeling tense,stressed, "uptight" or on edge
Not at all
Somewhat
Moderately
Severely
Not at all
Somewhat
Moderately
Severely
Not at all
Somewhat
Moderately
Severely
Not at all
Somewhat
Moderately
Severely
Not at all
Somewhat
Moderately
Severely
Not at all
Somewhat
Moderately
Severely