English Anxiety Workshop Intake

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Anxiety Lunch Break Webinar
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6 Week Webinar Meetings will be held via Zoom on Tuesdays at 12:15-12:45 PM CDT. After registration and payment, you will receive a Zoom link to use for the meeting. We ask that you pay per person who will use the link and not share the link. Thank you
$60.00 Quantity

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Pre-Assessment

Please go through these brief anxiety assessments.

GAD7: how often have they been bothered by the following over the past 2 weeks?

	Not at all	Several Days	More than half the days	Nearly every day
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it's hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen

Do you have panic attacks?

YesNo
If yes, how many in the last month?
"N/A" if not
What physical symptoms do you experience?

Muscle ache/tensionHeadaches/migrainesRacing heart/palpitationsInsomniaDizzinessShortness of breathFatigueExcessive sweatingTrembling/shakingStomach acheTingling/pins and needlesDry mouthButterflies in your stomach
On a scale of 1 - 10 how disruptive are you symptoms to your life? (1 represents "not at all" and 10 is "extremely")
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