Anxiety Risk Assessment

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Anxiety Risk Assessment

Children, adolescents and adults can experience anxiety. Anxiety can be triggered by an event or by chronic stress. It can also happen without explanation and be the result of genetic or biological factors that the person has no ability to prevent.

Please fill in a value for the following field(s):

Do you spend a lot of time worrying about things you cannot change or control?

Yes	No

Are you afraid of or dread things but don't know why?

Yes	No

Do your thoughts race and jump around?

Yes	No

Do you feel restless edgy or unable to relax?

Yes	No

Are you irritable tense and uptight?

Yes	No

Do you have fears of fainting having a heart attack or dying?

Yes	No

Have you ever had an episode of intense fear that came on without warning?

Yes	No

Would you or others describe you as anxious or panicky?

Yes	No

Have you ever been to the ER or doctor's office due to fear of having a heart attack?

Yes	No

Do you avoid normal activities to not feel anxious or panicked?

Yes	No

Do you have trouble getting a good night's rest?

Yes	No

Is it hard to concentrate or make decisions?

Yes	No

Do others tell you to stop worrying so much?

Yes	No

Have you ever been afraid of losing control going crazy or had feelings of impending doom?

Yes	No

Do you worry a lot or consider yourself a nervous or anxious person?

Yes	No

Do you live alone?

Yes	No

Do you have people in your life who aren't helpful with your medical needs?

Yes	No

Do you tend to ignore your own medical symptoms or health problems?

Yes	No

Do you regularly find yourself angry, frustrated and/or impatient?

Yes	No

If you answered Yes to three or more of these questions, it is advisable that you seek treatment. If you have chest pain, heart palpitations, shortness of breath, fatigue or dizziness in combination with these symptoms, schedule to see your family doctor or cardiologist as soon as possible to rule out heart disease.

Lees Psychological Services offers treatment for anxiety and can help you with this problem. Anxiety is a serious problem and if left untreated, gets progressively worse. Treatment through psychological therapy and, if necessary, medication, is highly effective and benefits overall physical and emotional wellness.

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Lees Psychological Services, Inc.
The Center of Excellence 601 North 99th Street, Suite 307 Wauwatosa, WI 53226
414-774-6878 414-774-6879 fax