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Self-assessment · Screening only

Agoraphobia Self-Assessment
Use the result as a conversation starter.

This questionnaire can help organise current experiences. It cannot diagnose a condition, determine risk on its own or replace an assessment by a qualified professional.

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Private self-assessmentNot a diagnosisAll self-assessments
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1. Use this scale to indicate how much you would avoid each of the situations listed below because of fear or other unpleasant feelings:

Travelling alone on public transportation (e.g. bus or train)

 
 
 
 
 
 
 
 
 

2. Use this scale to indicate how much you would avoid each of the situations listed below because of fear or other unpleasant feelings:

Walking alone in busy streets

 
 
 
 
 
 
 
 
 

3. Use this scale to indicate how much you would avoid each of the situations listed below because of fear or other unpleasant feelings:

Going in to crowded shops

 
 
 
 
 
 
 
 
 

4. Use this scale to indicate how much you would avoid each of the situations listed below because of fear or other unpleasant feelings:

Going alone far from home

 
 
 
 
 
 
 
 
 

5. Use this scale to indicate how much you would avoid each of the situations listed below because of fear or other unpleasant feelings:

Large open spaces

 
 
 
 
 
 
 
 
 

Question 1 of 5

After the test

A higher or lower score does not confirm or exclude a diagnosis. Consider duration, distress, daily function and professional assessment. Use the patient form if you would like to discuss an appropriate next step.

Next step

Put the score
back into context.

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