James Fitzgerald Therapy, PLLC

James Fitzgerald, MS, NCC, AAP, Psychotherapist

Strengthening Your Conscious Self © 2022

Intake Assessment

Hamilton Rating Scale for Anxiety (HAM A)

This assessment should be completed by your provider, in sessions. Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, where <17 indicates mild severity, 18–24 mild to moderate severity and 25–30 moderate to severe.

Client ID and Date Started

Instructions

Below is a list of phrases that describe certain feeling that people have. Rate the client's experience by finding the answer which best describes the extent to which the client has these conditions. Select one of the five responses for each of the fourteen questions.
Worries, anticipation of the worst, fearful anticipation, irritability.
Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
Difficulty in concentration, poor memory.
Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.
Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
Pressure or constriction in chest, choking feelings, sighing, dyspnea.
Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.
Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.
Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.
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