SH046-01-Amen-Tipus-ADD-אמן-טיפוס-Hebrew5 (1)

בס''ד
Questionnaire GAD 7
Name:*
Last Name:*
Filled by: *
Date:*

MonthDayYear
Date
Code:
Birthdate:*

MonthDayYear
Date
Date2

MonthDayYear
Date
גיל בשנים
Age:
Mail:
The completed form will be sent to this email address
To be able to help in the best possible way, please take the necessary time to fill out this questionnaire in the most accurate way possible. Of course, all details will be kept strictly confidential
Over the last 2 weeks, how often have you been bothered by the following problems?
0 - Not at all

1 - Several days

2 - More than half the days

3 - Nearly every day

	0	1	2	3
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen

Questionnaire GAD 7