Generalized Anxiety Disorder 7-item (GAD-7)
First Name
*
Last Name
*
Date of Birth
Visit Date
Over the
last two weeks
, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
2. Not being able to stop or control worrying
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
3. Worrying too much about different things
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
4. Trouble relaxing
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
5. Being so restless that it is hard to sit still
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
6. Becoming easily annoyed or irritable
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
7. Feeling afraid, as if something awful might happen
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
Column Totals
__________ __________ __________ __________
Total Score
(add your column totals) __________
If you checked any problems, 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