GAD-7

FULL NAME*

First NameLast Name

Birth Date*

MonthDayYear

Over the last two weeks, how often have you been bothered by the following problems? *

Rows	Not at all	Several Days	More than half the days	Nearly Every day
1. Feeling nervous, anxious, or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid, as if something awful might happen

Not difficult at allSomewhat DifficultVery DifficultExtremely Difficult

GAD-7 SCORE