Beck Anxiety Inventory

BECK ANXIETY INVENTORY

BAI

* Indicates required field

Client's Full Name *

First

Last

Client's Date of Birth (MM/DD/YYYY) *

Below is a list of common symptoms of anxiety. Please read each item in the list. Indicate from the drop down list how much you have been bothered by that symptom during the past month, including today.

Numbness or tingling *

Hands trembling *

Feeling hot *

Shaky / unsteady *

Wobbliness in legs *

Fear of losing control *

Unable to relax *

Difficulty in breathing *

Fear of worst happening *

Fear of dying *

Dizzy or lightheaded *

Scared *

Heart pounding/racing *

Indigestion *

Unsteady *

Faint / lightheaded *

Terrified or afraid *

Face flushed *

Nervous *

Hot / cold sweats *

Feeling of choking *

Name of Clinician *

Date of Assessment (MM/DD/YYYY) *

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