Self-Rating Anxiety Scale (SAS)
For each item below, please place a check mark in the column which best describes how often you felt or behaved this way during the past several days. Bring the completed form with you to the office for scoring and assessment during your office visit.
I feel more nervous and anxious than usual.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I feel afraid for no reason at all.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I get upset easily or feel panicky.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I feel like I'm falling apart and going to pieces.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I feel that everything is all right and nothing bad will happen.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
My arms and legs shake and tremble.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I am bothered by headaches neck and back pain.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I feel weak and get tired easily.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I feel calm and can sit still easily.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I can feel my heart beating fast.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I am bothered by dizzy spells.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I have fainting spells or feel like it.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I can breathe in and out easily.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I get feelings of numbness and tingling in my fingers toes.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I am bothered by stomach aches or indigestion.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I have to empty my bladder often.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
My hands are usually dry and warm.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
My face gets hot and blushes.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I fall asleep easily and get a good night's rest.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
I have nightmares.
A little ofthe time
Some ofthe time
Good partof the time
Most ofthe time
