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Zung Self Rating Anxiety Scale

Page One

This question requires a valid date format of MM/DD/YYYY.
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Who is it who has asked you to fill out this form? - choose one
For each item below, choose the answer which best describes how often you felt or behaved this way during the past several days.
I feel more nervous and anxious than usual. *This question is required.
I feel afraid for no reason at all. *This question is required.
I get upset easily or feel panicky *This question is required.
I feel like I'm falling apart and going to pieces. *This question is required.
I feel that everything is all right and nothing bad will happen. *This question is required.
My arms and legs shake and tremble. *This question is required.
I am bothered by headaches neck and back pain. *This question is required.
I feel weak and get tired easily. *This question is required.
I feel calm and can sit still easily. *This question is required.
I can feel my heart beating fast. *This question is required.
I am bothered by dizzy spells. *This question is required.
I have fainting spells or feel like it. *This question is required.
I can breathe in and out easily *This question is required.
I get feelings of numbness and tingling in my fingers & toes. *This question is required.
I am bothered by stomach aches or indigestion. *This question is required.
I have to empty my bladder often. *This question is required.
My hands are usually dry and warm. *This question is required.
My face gets hot and blushes. *This question is required.
I fall asleep easily and get a good night's rest. *This question is required.
I have nightmares. *This question is required.
Scores 20-44 Normal Range 45-59 Mild to Moderate Anxiety Levels 60-74 Marked to Severe Anxiety Levels 75-80 Extreme Anxiety Levels