TMS Health Center - Anxiety Test

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

Email* This field is required.

example@example.com

4

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

5

Feeling nervous, anxious, or on edge* This field is required.

Not at all

Several days

More than half the days

Nearly every day

6

Not being able to stop or control worrying* This field is required.

Not at all

Several days

More than half the days

Nearly every day

7

Worrying too much about different things* This field is required.

Not at all

Several days

More than half the days

Nearly every day

8

Trouble relaxing* This field is required.

Not at all

Several days

More than half the days

Nearly every day

9

Being so restless that it is hard to sit still* This field is required.

Not at all

Several days

More than half the days

Nearly every day

10

Becoming easily annoyed or irritable* This field is required.

Not at all

Several days

More than half the days

Nearly every day

11

Feeling afraid, as if something awful might happen* This field is required.

Not at all

Several days

More than half the days

Nearly every day

12

If you checked any problems, how difficult have they made it for you to do your work, take care ofthings at home, or get along with other people?* This field is required.

Not difficult

Somewhat difficult

Very difficult

Extremely difficult

13

GAD-7 Anxiety Scale ScoreClick next to see what this means

14

Your results suggest minimal anxiety. If you would like to discuss possible treatment options for your anxiety click next for contact options.

15

Your results suggest mild anxiety. If you would like to discuss possible treatment options for your anxiety click next for contact options.

16

Your results suggest moderate anxiety. If you would like to discuss possible treatment options for your anxiety click next for contact options.

17

Your results suggest severe anxiety. If you would like to discuss possible treatment options for your anxiety click next for contact options.

18

Would you be interested to hear and talk about our services?* This field is required.

YESNO

19

Preferred Contact Method

Call

Text

Email

20

When is the best time to reach you?

Morning

Afternoon

Evening