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Generalized Anxiety Disorder 7 (GAD-7)
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Name
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Your answer
DOB
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MM
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DD
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Over the last 2 weeks, how often have you been bothered by the following problems...
Feeling nervous, anxious, or on edge?
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Not at all
Several days
More than half the days
Nearly every day
Not being able to stop or control worrying?
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Not at all
Several days
More than half the days
Nearly every day
Worrying too much about different things?
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Not at all
Several days
More than half the days
Nearly every day
Trouble relaxing?
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Not at all
Several days
More than half the days
Nearly every day
Being so restless that it is hard to sit still
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Not at all
Several days
More than half the days
Nearly every day
Becoming easily annoyed or irritable
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Not at all
Several days
More than half the days
Nearly every day
Feeling afraid, as if something awful might happen
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Not at all
Several days
More than half the days
Nearly every day
If you checked any problems above, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
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