About this template
Understanding and evaluating client or patient anxiety is critical for providing effective mental health support, counseling, and treatment planning. This Anxiety Questionnaire Google Form Template provides a structured, compassionate way to screen for anxiety symptoms, measure frequency, and identify underlying triggers.
Designed for clinicians, counselors, therapists, and wellness coaches, this form streamlines initial mental health intake and ongoing progress tracking. Respondents can securely detail their symptoms, frequency of worry, and potential stress factors, allowing practitioners to review insights instantly. By moving away from cumbersome paper assessments, mental health professionals can collect structured data digitally, making triage and consultation preparation faster and more organized.
Key features
- Screen for anxiety symptoms and frequency in a structured format.
- Identify specific worry triggers and lifestyle stress factors.
- Streamline initial client intake for therapy and counseling sessions.
- Collect responses securely and access results instantly in Google Sheets.
- Easily customize questions to fit clinical guidelines or wellness programs.
Use cases
Initial intake assessments for new therapy and counseling clients.
Progress tracking and follow-up evaluations during ongoing treatment.
Mental health screenings for telehealth and remote appointments.
Wellness check-ins and stress evaluations for employee assistance pro…
Wellness check-ins and stress evaluations for employee assistance programs.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Select your date of birth.
- Email Address (Short answer)Enter the best email address to reach you.
- Primary Reason for Completing This Questionnaire (Paragraph)Briefly describe what prompted you to complete this assessment today.
- Feeling nervous, anxious, or on edge (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Not being able to stop or control worrying (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Worrying too much about different things (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Trouble relaxing (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Being so restless that it is hard to sit still (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Becoming easily annoyed or irritable (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Feeling afraid as if something awful might happen (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Primary Stress Triggers (Checkboxes)Select the main areas of your life that currently contribute to your stress or anxiety.
- Overall Anxiety Level (Linear scale)Rate your overall level of anxiety on average over the past month.
- Coping Strategies and Additional Notes (Paragraph)Share anything else regarding your symptoms or what helps you cope when feeling anxious.
FAQ
How do I customize this anxiety questionnaire?
Once you copy the template to your Google Drive, you can easily add, remove, or edit questions using the Google Forms editor to match your specific clinical requirements.
Where are the questionnaire responses stored?
All submissions are securely saved in your Google Account and can be automatically linked to a Google Sheet for easy review and analysis.
Can I use this form for telehealth and remote sessions?
Yes! You can easily share the form link via email or messaging before a virtual appointment so patients can complete it in advance.
Is this form suitable for ongoing client monitoring?
Absolutely. You can send the questionnaire periodically to track changes in anxiety levels and treatment outcomes over time.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.