GAD-7 Anxiety Assessment Form
Date
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Month
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Day
Year
Date
Full Name
*
First Name
Last Name
Gender
Date of Birth
*
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Month
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Day
Year
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Instructions: Over the last 2 weeks, how often have you been bothered by the following problems? Please answer each item.
GAD-7 Items
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Rows
Not at all
Several days
More than half the days
Nearly every day
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it's hard to sit still
Becoming easily annoyed or irritable
Feeling afraid, as if something awful might happen
If you checked any problems above, how difficult have these 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
Is there anything else you would like to share about your anxiety or mental health?
Submit Assessment
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