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Get A Free Consultation Phone Appointment

Charles Beeson, CHt
Clinical Hypnotherapist
+1 (256) 853-0286
cbeeson@instacalm.com

Getting Started
Anxiety Disorder Treatments
How It Works
Alcohol Treatment
YouTube Videos
Success Stories
All About Anxiety
- Top 10 Self-Help Techniques
- Blog
About Us
Mobile App
- How to Use the Best Anxiety App
Contact
- Client Registration

Anxiety Rating Testripesol2023-06-08T16:25:17+00:00

Get Started by Taking the Anxiety Rating Test & Scheduling Your Free Phone Consultation with Charles Beeson, CHt.

Step 1 of 5

20%

Name*
First Last
Email*
Cell Phone*
Disclaimer: This form is not a diagnostic instrument and is only to be used for educational, self-help purposes, within the context of your medical treatment, and by you, if you are at least 18 years of age. Share your checklist responses and assessment with your physician or other healthcare provider. The maker and provider of this form, InstaCalm, Inc., and all sponsoring partners, disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material. Please take the time to fill out the below form as accurately, honestly and completely as possible. All of your responses are confidential.

Feeling nervous or tense (unable to relax)*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
My life is very stressful*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
I feel worried, scared or fearful*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
I feel anxious*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Difficulty Sleeping*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Anxiety or Panic Attacks (Racing Heart & Rapid Breathing)*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Shaking or trembling*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Chest pain or discomfort*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Irritable or angry*
- Never
- Rarely
- Sometimes
- Often
- Most of the times

Fear of losing control*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Avoid situations, certain locations or leaving the house because of anxiety*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Racing or pounding heart*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Anxious or very nervous in social situations*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Fear of public speaking, speaking to groups or giving presentations*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Fear of flying*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Fear of closed in spaces or being trapped*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Feeling detached or not in your body*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Feeling lightheaded or faint*
- Never
- Rarely
- Sometimes
- Often
- Most of the times

I am jumpy or startle easily*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
I think negative or persistent uncomfortable thoughts*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
My fears and anxiety affects my family, marriage or relationships*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Fear of dying*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Abdominal pain or discomfort*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Difficulty breathing or shortness of breath*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
My anxiety interferes with my job or school*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Sweating*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
I use drugs or alcohol to deal with my anxiety*
- Never
- Rarely
- Sometimes
- Often
- Most of the times

feeling of choking*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Obsessive checking and rechecking things*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Feeling sad or depressed*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Chills or hot flashes*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Fear of driving or being driven in an automobile*
- Never
- Rarely
- Sometimes
- Often
- Most of the times
Gender?*
- Male
- Female
What is your Age Range?*
- Below 18 (Minor/Child)
- 18 to 25
- 26 to 36
- 37 to 55
- 55 to 69
- Over 70
How long have you been dealing with your anxiety?*
- Less than 3 months
- 3 Months to 1 year
- 1 to 5 years
- 5 to 20 years
- Greater than 20 years
Have you ever been diagnosed with anxiety by a medical or mental health professional?*
- Yes
- No
Are you presently receiving help with any of the following?*
- Anxiety Medication
- Depression Medication
- Therapy/Counseling
- Physician/Psychiatrist
- Self-Help Techniques
- None of Above
Did you have any stressful emotional events just prior to the onset of your anxiety?*
- Yes
- No

Get Your Free, Confidential 15 minute Phone Consultation with Charles R. Beeson, CHt.

710 Nick Fitcheard Rd. NW
Suite 1005
Huntsville, Alabama 35806

Mobile : (256) 863-7722
Email : cbeeson@instacalm.com

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Generalized Anxiety Disorder

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Performance & Situational Anxiety

Stage Fright Performance

Public Speaking Anxiety

Exam / Test Anxiety Treatment

Fear of Driving Anxiety

Fear of Flying Anxiety

Self-Help Resources (Top 10 Techniques)

All About Anxiety

Practice Relaxation Techniques

5:7 Breathing Technique

Exercise Reduces Anxiety

Take Care of Your Body (Physiology)

Have Fun and Make Love

Stop Worry Instantly!

Trigger Calm-Confidence With Anchoring

Stopping Anxious Thoughts

Stop Panic Attacks in Seconds

Improve Self Confidence

Blog Posts

Alcohol Treatment & Recovery Hypnotherapy

How to Get Started Overcoming Anxiety

How To Stop Panic Attacks Naturally Without Medication or Talk-Therapy

Common Types & Symptoms of Anxiety

One thing to never do when having an Anxiety attack

Fears & Phobias

What’s The Cause & How to Stop Anxiety Attacks

How to Turn Off Nervousness Like a Light-Switch

Cognitive Behavioral Hypnotherapy Treatment for Anxiety

How Stressful Memories Affect Anxiety

The 3 Keys to Ending Anxiety

Child & Teenage Anxiety

Break Free of Social Anxiety

Comparison of Anxiety Treatments

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