Anxiety Questionnaire (GAD7)

1

Full Name* This field is required.Enter your Full Name

First Name

Last Name

2

Feeling nervous, anxious, or on-edge?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

3

Not being able to stop or control worrying?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

4

Worrying too much about different things?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

5

Trouble relaxing?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

6

Being so restless that it's hard to sit still?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

7

Becoming easily annoyed or irritable?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

8

Feeling afraid as if something awful might happen?* This field is required.Over the past 2 weeks, how often have been bothered by the following:

Not at all

Several Days

More than Half the Days

Nearly Every Day

9

How difficult have these symptoms 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

10

Date

11

FINAL SCORE