Illinois Institute for Integrated Mental Health

Dr. Eldin Dzudza, MD

PATIENT PORTAL
401 N. Michigan Ave., Suite 1239 • Chicago, IL
4770 N. Lincoln, Suite 7 • Chicago, IL
(312) 467-0903
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Anxiety Questionnaire

Do you feel apprehensive most of the time?
Yes

No

Do you have a sense of impending danger, panic or doom?
Yes

No

Does you heart go a mile a minute, even though you’re in great shape?
Yes

No

Have you experienced any panic attacks lately?
Yes

No

Do you worry to the point that it’s interfering with your work or relationships?
Yes

No

Do you feel powerless?
Yes

No

Do you constantly feel stressed out?
Yes

No

If you answered yes to any of these questions, please contact us today to see how you can feel fine fast.

Please call my office to schedule an appointment at (312) 467-0903.

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