Beck Anxiety Inventory (BAI) Questionnaire Form
Please complete this Beck Anxiety Inventory (BAI) Questionnaire Form to help assess the frequency of anxiety symptoms over a recent period.
Your initials
Age group
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Reference period for responses
*
Past week
Past two weeks
Past month
How would you like to respond?
*
Select a rating for each symptom
Choose the most accurate statement for each symptom
Numbness or tingling
*
Not at all
Mildly, but it didn't bother me much
Moderately—it wasn't pleasant at times
Severely—it bothered me a lot
Feeling hot
*
Not at all
Mildly, but it didn't bother me much
Moderately—it wasn't pleasant at times
Severely—it bothered me a lot
Wobbliness in legs
*
Not at all
Mildly, but it didn't bother me much
Moderately—it wasn't pleasant at times
Severely—it bothered me a lot
Unable to relax
*
Not at all
Mildly, but it didn't bother me much
Moderately—it wasn't pleasant at times
Severely—it bothered me a lot
Fear of the worst happening
*
Not at all
Mildly, but it didn't bother me much
Moderately—it wasn't pleasant at times
Severely—it bothered me a lot
How much have anxiety symptoms impacted your daily life during the reference period?
*
No impact
Mild impact
Moderate impact
Severe impact
Additional comments or follow-up preference (optional)
Submit
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