Anxiety Screening Tool
by Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues
Generalized Anxiety Disorder (GAD) Screening Tool
This is a screening measure to help you determine whether you might have Generalized Anxiety Disorder (GAD) that needs professional attention. This screening tool is not designed to make a diagnosis of GAD but to be shared with your primary care physician or mental health professional to inform further conversations about diagnosis and treatment.
Patient Name
*
First Name
First and last letter of last name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
During the last six months, have you been bothered by excessive worries more days than not?
*
Yes
No
Do you worry excessively or uncontrollably about minor things such as being late for an appointment, miror repairs, homework, etc.?
*
Yes
No
Do you find it difficult to control the worry or stop worrying once it starts?
*
Yes
No
Do you experience excessive worry?
*
Yes
No
Is your worry excessive in intensity, frequency, or amount of distress it causes?
*
Yes
No
Please list below the most frequent topics about which you worry excessively or uncontrollably.
*
On a scale of 0 to 8, during the past six months, have you often been bothered by any of the following symptoms? [0=Not at All, 4=Moderately, 8=Extremely]
*
Rows
0
1
2
3
4
5
6
7
8
Restlessness or feeling keyed up or on edge
Irritability
Difficulty falling/staying asleep or restless /unsatisfying sleep
Being easily fatigued
Difficulty concentrating or mind going blank
Muscle tension
On a scale of 0 to 8, during the past six months, have you often been bothered by any of the following symptoms? [0=Not at All, 4=Moderately, 8=Extremely]
*
Rows
0
1
2
3
4
5
6
7
8
Work
Social activities
Family relationships
Friendships
On a scale of 0 to 8, during the past six months, have you often been bothered by any of the following symptoms? [0=Not at All, 4=Moderately, 8=Extremely]
*
Rows
0
1
2
3
4
5
6
7
8
Distressed by worry and physical symptoms
Date
*
-
Month
-
Day
Year
Date
Patient Signature
*
Print Form
Continue
Continue
PHQ-9 Score (0-4 Minimal) (5-9 Mild) (10-14 Moderate) (15-19 Moderately-Severe) (20+ Severe)
GAD-7 Score (0-5 Minimal) (6-10 Mild) (11-15 Moderate) (16-21 Severe)
Should be Empty: