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General Anxiety Disorder Assessment (GAD7)
Over the last two weeks, how often have you been bothered by any of the following problems?
* Indicates required question
Email
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Your email
Patient Name
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Your answer
Patient date of birth
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MM
/
DD
/
YYYY
Feeling nervous, anxious, or on edge
*
Choose
Not at all
1 - Several days
2 - More than half of the days
3- Nearly every day
Not being able to stop or control worrying
*
Choose
Not at all
1- Several days
2 - More than half of the days
3 - Nearly every day
Worrying too much about different things
*
Choose
Not at all
1- Several days
2 - More than half of the days
3 - Nearly every day
Trouble relaxing
*
Choose
Not at all
1- Several days
2 - More than half of the days
3 - Nearly every day
Being so restless that it's hard to sit still
*
Choose
Not at all
1 - Several days
2 - More than half of the days
3 - Nearly every day
Becoming easily annoyed or Irritable
*
Choose
Not at all
1 - Several days
2 - More than half of the days
3 - Nearly every day
Feeling afraid as if something awful might happen
*
Choose
Not at all
1 - Several days
2 - More than half of the days
3 - Nearly every day
If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
*
Not difficult at all
1 - Somewhat difficult
2 - Very difficult
3 - Extremely difficult
Required
Survey developed by
Spitzer RL, Kroenke K, Williams JB, Lowe B: A brief measure for assessing generalized anxiety disorder: the GAD-7, Archives of Internal Medicine, 2006 May 22;166(10):1092-7.
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