Template library · Assessments & screeners
Social Anxiety Screen template
Rate how much fear or avoidance you experience in the following situations.
Screen for social anxiety symptoms and avoidance
- 20 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Fear / Avoidance
- 1. Speaking in front of a groupChoice
- 2. Meeting new peopleChoice
- 3. Eating or drinking in front of othersChoice
- 4. Being the center of attentionChoice
- 5. Making phone calls in publicChoice
- 6. Attending social gatheringsChoice
- 7. Assertively expressing disagreementChoice
Functional Impact
- Effect on work / school performanceText
- Effect on relationshipsText
- Coping or avoidance strategies usedText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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