Home Accessing Support Questionnaires Anxiety and Level of Worry Anxiety and Level of Worry Contact Information First Name * Last Name * Date Of Birth * Telephone Number * Email Address * Reference 1. How is your day to day mood? Very good Good Okay Worried Very Worried 2. How are work tasks and day to day activities Cope well It’s a bit of a struggle I have little interest in achieving things I really struggle to engage with tasks for a couple of hours or more I cannot engage in tasks at all 3. Social interactions I socialise with people in my daily life as well as I ever have done I still generally socialise but it’s harder than it used to be I am finding it hard even to be with my friends I am finding hard to socialise with anyone I am now isolating most people 4. Sexual interest I really enjoy sex I enjoy sex most of the time I practice sex but I don’t really enjoy it now I am finding hard to socialise with anyone I am now isolating most people 5. Appetite I am eating all of the time I am eating much more than I normally do I am eating more than I normally do I am eating the same as I normally I am eating less than I normally do I am eating much less than I normally do I am not eating at all 6. Weight I have gained 15lbs or more recently I have gained 10lbs or more recently I have gained 5lbs or more recently My weight is the same + or – 2lbs I have lost 15lbs or more recently 7. Agitation I have no agitation I fidget more than I did I find myself playing with my hair, hand etc. more than I did I find it harder to be still than I used to I now bite my lips, hands or pull my hair, wring my hands etc .more than I used to 8. I imagine future conversations Not at all A little Some of the time Most of the time All of the time 9. I imagine the worst happening Not at all A little Some of the time Most of the time All of the time 10. Sleeping As normal Less than normal, wake a couple of hours too early Less than normal, it takes me a couple of hours to get to sleep I sleep after a struggle but wake often A lot less than normal, wake several hours too early 11. I feel very tired when I am should normally be awake and alert: Not at all A little Some of the time Most of the time All of the time 12. I find hard to concentrate Not at all A little Some of the time Most of the time All of the time Send Form Posted on 19 September 2020 at 7:02 pm.