Ingrid Oliansky, Licensed Marriage and Family Therapist
MFC# 48975
Call for an appointment (818) 927-3855
HomeAbout ServicesContact FAQForms


Anxiety Inventory Page 2
Difficulty concentrating
Racing Thoughts
Frightening Thoughts
Feeling that you are on the verge of losing control
Fears of cracking up or going crazy
Fears of fainting or passing out
Fears of physical illness, heart attack or dying
Concerns about looking foolish or inadequate
Fears of being alone, isolated or abandoned
Fears of criticism or disapproval
Fears that something terrible is about to happen.
Name:
Date:
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
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