GAD-7 (General Anxiety Disorder-7)
Measures severity of anxiety
Patient Name
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First Name
Last Name
Date of Birth
*
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Month
-
Day
Year
Date
Today's Date
*
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Month
-
Day
Year
Date
Over the last two weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
2. Not being able to stop or control worrying
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
3. Worrying too much about different things
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
4. Trouble relaxing
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
5. Being so restless that it is hard to sit still
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
6. Becoming easily annoyed or irritable
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
7. Feeling afraid, as if something awful might happen
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Not at all (0)
Several days (+1)
More than half the days (+2)
Nearly every day (+3)
Scoring GAD-7 Anxiety Severity
What range did your score fall under?
0–4: minimal anxiety
5–9: mild anxiety
10–14: moderate anxiety
15–21: severe anxiety
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 all
Somewhat difficult
Very difficult
Extremely difficult
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