GAD-7

GAD-7 Anxiety Screening
Patient Name:*
Date of Birth:*

MonthDayYear
Date
Date of Assessment:*

MonthDayYear
Date
Over the last 2 weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
2. Not being able to stop or control worrying*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
3. Worrying too much about different things*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
4. Trouble relaxing*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
5. Being so restless that it is hard to sit still*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
6. Becoming easily annoyed or irritable*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
7. Feeling afraid as if something awful might happen*

0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day
Total GAD-7 Score
Scores range from 0 to 21. Higher scores indicate greater severity of anxiety symptoms.
GAD-7 scores range from 0 to 21:

•0-4: Minimal Anxiety

•5-9: Mild Anxiety

•10-14: Moderate Anxiety

•15-21: Severe Anxiety
Should be Empty:

GAD-7 Anxiety Screening