General Anxiety Disorder-7
Patient Name
First Name
Last Name
Patient Date of Birth
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Over the last 2 weeks, how often have you been bothered by the following problems?
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Rows
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
Submit
Score - 0–4: minimal anxiety, 5–9: mild anxiety, 10–14:moderate anxiety, 15–21: severe anxiety
Should be Empty: