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

If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?

GAD-7 SCORE