GAD-7 Scale

General Anxiety Disorder (GAD-7) Scale

Please answer as honestly as you can.
Main: 631-881-4569 | Fax: 631-944-8000 | Email: dovepsychiatry624@gmail.com
Patient Name:*

First NameLast Name
Date Of Birth:*

MonthDayYear
Date
Email*
example@example.com

Over the last two weeks, how often have you been bothered by the following problems?*

	Not At All	Several Days	More Than Half The Days	Nearly Every Day
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

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 AllSomewhat DifficultVery DifficultExtremely Difficult
Scoring GAD-7 Anxiety Severity:

This is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively,
of “not at all,” “several days,” “more than half the days,” and “nearly every day.”
GAD-7 total score for the seven items ranges from 0 to 21.
0–4: minimal anxiety
5–9: mild anxiety
10–14: moderate anxiety
15–21: severe anxiety

Reference: Anxiety & Depression Association of America, ADAA
Should be Empty:

General Anxiety Disorder (GAD-7) Scale