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CEREC Same Day Crowns
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TMJ, TMD, and Orofacial Pain
TMJ/TMD Therapy
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Therapeutic Botox
Splints & Nightguards
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Cold Sore Treatment
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180 9 St NE #100, Calgary, AB T2E 0P4, Canada
(403) 294 1077
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180 9 St NE #100, Calgary, AB T2E 0P4, Canada
info@alpinedentalcare.ca
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About
About Us
Meet Our Team
CDCP Plan
Blog
Gallery
New Patients
New Patient Forms
Confidential Information Questionnaire
Dental History
Medical History
Epworth Sleep Scale
Beck Anxiety Inventory
Beck’s Depression Inventory
Medical History Update
Patient Resources
Videos
Services
General & Preventative Dentistry
Dental Exams & Checkups
Professional Teeth Cleanings
Preventative Dentistry
White Fillings
Night Guards & Sports Guards
Splints
Independent Dental Exams
Oral Sedation
Sleep Dentistry
Sleep Apnea and Snoring Appliances
Mandibular Advancement Devices
Children’s Dentistry
Children’s Dentistry
Oral Health Education
Preventative Care for Children
Emergency Dentistry
Invisalign
Restorative Dentistry
Dental Crowns
Dental Bridges
Dental Implants
Root Canals
Tooth Extractions
Wisdom Teeth Extractions
Same-Day Dentistry
CEREC Same Day Crowns
Cosmetic Dentistry
Dental Veneers
Teeth Whitening
Cosmetic Botox
TMJ, TMD, and Orofacial Pain
TMJ/TMD Therapy
Facial Pain Treatment
Atypical Odontalgia Treatment
Therapeutic Botox
Splints & Nightguards
Additional Services
Laser Labial Frenectomy
Cold Sore Treatment
Periodontal Treatments
Referral
Contact
About
About Us
Meet Our Team
CDCP Plan
Blog
Gallery
New Patients
New Patient Forms
Confidential Information Questionnaire
Dental History
Medical History
Epworth Sleep Scale
Beck Anxiety Inventory
Beck’s Depression Inventory
Medical History Update
Patient Resources
Videos
Services
General & Preventative Dentistry
Dental Exams & Checkups
Professional Teeth Cleanings
Preventative Dentistry
White Fillings
Night Guards & Sports Guards
Splints
Independent Dental Exams
Oral Sedation
Sleep Dentistry
Sleep Apnea and Snoring Appliances
Mandibular Advancement Devices
Children’s Dentistry
Children’s Dentistry
Oral Health Education
Preventative Care for Children
Emergency Dentistry
Invisalign
Restorative Dentistry
Dental Crowns
Dental Bridges
Dental Implants
Root Canals
Tooth Extractions
Wisdom Teeth Extractions
Same-Day Dentistry
CEREC Same Day Crowns
Cosmetic Dentistry
Dental Veneers
Teeth Whitening
Cosmetic Botox
TMJ, TMD, and Orofacial Pain
TMJ/TMD Therapy
Facial Pain Treatment
Atypical Odontalgia Treatment
Therapeutic Botox
Splints & Nightguards
Additional Services
Laser Labial Frenectomy
Cold Sore Treatment
Periodontal Treatments
Referral
Contact
(403) 294-1077
Book Online
Beck Anxiety Inventory
Patient's Legal Name:
(Required)
First
Last
Date of Birth:
(Required)
Month
Month
1
2
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12
Day
Day
1
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Year
Year
2026
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Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by clicking the number in the corresponding space in the column next to each symptom.
0. Not At All
1. Mildly but it didn’t bother me much.
2. Moderately - it wasn’t pleasant at times
3. Severely - it bothered me a lot
Numbness or tingling
0
1
2
3
Feeling hot
0
1
2
3
Wobbliness in legs
0
1
2
3
Unable to relax
0
1
2
3
Fear of worst happening
0
1
2
3
Dizzy or lightheaded
0
1
2
3
Heart pounding/racing
0
1
2
3
Unsteady
0
1
2
3
Terrified or afraid
0
1
2
3
Nervous
0
1
2
3
Feeling of choking
0
1
2
3
Hands trembling
0
1
2
3
Shaky / unsteady
0
1
2
3
Fear of losing control
0
1
2
3
Difficulty in breathing
0
1
2
3
Fear of dying
0
1
2
3
Scared
0
1
2
3
Indigestion
0
1
2
3
Faint / lightheaded
0
1
2
3
Face flushed
0
1
2
3
Hot / cold sweats
0
1
2
3
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