Generalized Anxiety Disorder 7-item (GAD-7)

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Date of Birth  

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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