GAD-7 Clinical Screening Form
Please note: this form is not currently submitted through a HIPAA-compliant system, so confidentiality of your responses cannot be fully guaranteed in transit and storage. Please avoid including any information you would not want stored on a standard, non-HIPAA-compliant platform.Enter your details and rate how often the listed symptoms bothered you over the past 2 weeks.
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Date of Completion
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Over the last 2 weeks, how often have you been bothered by the following problems?
GAD-7 Questionnaire
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Rows
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
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 is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid, as if something awful might happen
Total GAD-7 Score
GAD-7 Severity Bands:
0-4 Minimal
5-9 Mild
10-14 Moderate
15-21 Severe
Submit
Should be Empty: