Social Anxiety Disorder Assessment (Social Phobia) - Adult Self Report

Assessment 1 of 13

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. During the PAST 7 DAYS, I have felt moments of sudden terror, fear, or fright in social situations
2. During the PAST 7 DAYS, I have felt anxious, worried, or nervous about social situations
3. During the PAST 7 DAYS, I have had thoughts of being rejected, humiliated, embarrassed, ridiculed, or offending others
4. During the PAST 7 DAYS, I have felt a racing heart, sweaty, trouble breathing, faint, or shaky in social situations
5. During the PAST 7 DAYS, I have felt tense muscles, felt on edge or restless, or had trouble relaxing in social situations
6. During the PAST 7 DAYS, I have avoided, or did not approach or enter, social situations
7. During the PAST 7 DAYS, I have left social situations early or participated only minimally (e.g., said little, avoided eye contact)
8. During the PAST 7 DAYS, I have spent a lot of time preparing what to say or how to act in social situations
9. During the PAST 7 DAYS, I have distracted myself to avoid thinking about social situations
10. During the PAST 7 DAYS, I have needed help to cope with social situations (e.g., alcohol or medications, superstitious objects)