Beck Anxiety Inventory

Beck Anxiety Inventory
Patient Name

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Patient Date of Birth

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Beck Anxiety Inventory (BAI)

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

Rows	Not At All	Mildly but it didn’t bother me much	Moderately - it wasn’t pleasant at times	Severely – it bothered me a lot
Numbness or tingling
Feeling hot
Wobbliness in legs
Unable to relax
Fear of worst happening
Dizzy or lightheaded
Heart pounding/racing
Unsteady
Terrified or afraid
Nervous
Feeling of choking
Hands trembling
Shaky / unsteady
Fear of losing control
Difficulty in breathing
Fear of dying
Scared
Indigestion
Faint / lightheaded
Face flushed
Hot/cold sweats

BAI Total Score
Score of 0-21 = low anxiety
Score of 22-35 = moderate anxiety
Score of 36 and above = potentially concerning levels of anxiety
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Beck Anxiety Inventory

Beck Anxiety Inventory (BAI)