Anxiety Tracker Form

Anxiety Tracker Form — Form Fields

This personal template includes 8 fields. Log anxiety episodes with triggers, severity, and coping strategies to identify patterns and share with a therapist. Free to customize and use on ZenBuild.

• Date & Time (text, required)
• Anxiety Level (dropdown selection, required) — options: 1 - Very Mild, 2 - Mild, 3 - Moderate, 4 - High, 5 - Severe
• Possible Trigger (text, optional)
• Physical Symptoms (checkboxes, required) — options: Racing Heart, Sweating, Shortness of Breath, Tightness in Chest, Nausea, Dizziness, Trembling
• Coping Strategy Used (text, optional)
• Duration of Episode (minutes) (number, optional)
• How Well Did Your Coping Strategy Work? (1-5) (rating, optional)
• Additional Notes or Reflection (long text, optional)