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Anxiety Assessment Name E-Mail Address 1: Feeling keyed-up, on edge or restless? Yes No 2: Feeling stressed most of the time? Yes No 3: Having trouble sleeping or getting to sleep? Yes No 4: Feeling fatigued? Yes No 5: Having trouble concentrating or mind goes blank? Yes No 6: Feeling irritable, can't relax or uptight? Yes No 7: Noticing heart beating fast or muscle tension? Yes No 8: Feeling worried, anxious or fearful? Yes No 9: Feeling that something bad is going to happen? Yes No