Anxiety Screening Questionnaire (GAD-7)

Anxiety Screening Questionnaire

(GAD-7)
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Today's Date*

MonthDayYear
Date
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Not at allSeveral DaysOver half the daysNearly every day
Not at allSeveral DaysOver half the daysNearly every day
Not at allSeveral DaysOver half the daysNearly every day
Not at allSeveral DaysOver half the daysNearly every day
Not at allSeveral DaysOver half the daysNearly every day
Not at allSeveral DaysOver half the daysNearly every day
Not at allSeveral DaysOver half the daysNearly every day
If you checked off any problems, 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?*
Total Score:*

Scoring Guidelines: