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Get UTMB Geriatric Anxiety Scale (Short Version)

Jeff Baker Ph. D. - Course Coordinator - 409 772-9576 Geriatric Anxiety Scale Short Version Developed by Jeff Baker Ph. D. - To be used for Teaching Purposes Only Answers indicating anxiety are IN ALL CAPITALS See OnLine Form* Each answer in all CAPS counts one point scores greater than 5 indicates anxious symptoms the higher the score the more indication of anxiety. Student Last Name Student First Name Patient Initials Date Administered 1. Do you feel nervous much of the time 2. Have you worried about your future this week 3. Do you feel that your life is too fast 4. Do you often get anxious 5. Have you felt relaxed most of today 6. Are you feel afraid at different times during the day 7. Do you feel stress free most of the time 8. Does your stomach feel nervous much of the time 9. Do you prefer to have someone with you most of the time 10. Do you feel you have more anxiety than most 11. Do you find it easy to sleep at night 12. Do you feel pretty stressed now 15. D. - To be used for Teaching Purposes Only Answers indicating anxiety are IN ALL CAPITALS See OnLine Form* Each answer in all CAPS counts one point scores greater than 5 indicates anxious symptoms the higher the score the more indication of anxiety. Student Last Name Student First Name Patient Initials Date Administered 1. Do you feel nervous much of the time 2. Student Last Name Student First Name Patient Initials Date Administered 1. Do you feel nervous much of the time 2. Have you worried about your future this week 3. Do you feel that your life is too fast 4. Do you often get anxious 5. Have you worried about your future this week 3. Do you feel that your life is too fast 4. Do you often get anxious 5. Have you felt relaxed most of today 6. Are you feel afraid at different times during the day 7. Do you feel stress free most of the time 8. Have you felt relaxed most of today 6. Are you feel afraid at different times during the day 7. Do you feel stress free most of the time 8. Does your stomach feel nervous much of the time 9. Do you prefer to have someone with you most of the time 10. Does your stomach feel nervous much of the time 9. Do you prefer to have someone with you most of the time 10. Do you feel you have more anxiety than most 11. Do you find it easy to sleep at night 12. Do you feel pretty stressed now 15. D. - To be used for Teaching Purposes Only Answers indicating anxiety are IN ALL CAPITALS See OnLine Form* Each answer in all CAPS counts one point scores greater than 5 indicates anxious symptoms the higher the score the more indication of anxiety. Student Last Name Student First Name Patient Initials Date Administered 1. Do you feel nervous much of the time 2. Have you worried about your future this week 3. Do you feel that your life is too fast 4. Do you often get anxious 5. Student Last Name Student First Name Patient Initials Date Administered 1. Do you feel nervous much of the time 2. Have you worried about your future this week 3. Do you feel that your life is too fast 4. Do you often get anxious 5. Have you felt relaxed most of today 6. Are you feel afraid at different times during the day 7. Do you feel stress free most of the time 8. .

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