GAD-7
Over the
last 2 weeks
, how often have you been bothered by the following problems?
1. Feeling nervous, anxious or on edge
Not at all
Several days
More than half the days
Nearly every day
2. Not being able to stop or control worrying
Not at all
Several days
More than half the days
Nearly every day
3. Worrying too much about different things
Not at all
Several days
More than half the days
Nearly every day
4. Trouble relaxing
Not at all
Several days
More than half the days
Nearly every day
5. Being so restless that it is hard to sit still
Not at all
Several days
More than half the days
Nearly every day
6. Becoming easily annoyed or irritable
Not at all
Several days
More than half the days
Nearly every day
7. Feeling afraid as if something awfulmight happen
Not at all
Several days
More than half the days
Nearly every day
Name
*
First Name
Last Name
DOB
*
-
Month
-
Day
Year
Date
Therapist you’re scheduled with
*
First Name
Last Name
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(For office coding: Total Score T)
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