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GAD-7 (General Anxiety Disorder)

Community & Family Resources
211 Ave M West
Phone 515-576-7261
 Client Information
  First Name:  * Last Name:  *  
           
  Date of Birth:  * Birth Sex: 
* 
         
  Address: City:  
  State: Zip Code :  
  Phone No:  
Over the last 2 weeks, how often have you been bothered by any of the following problems? (Select the best answer.)
* 1. Feeling nervous, anxious or on edge
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
* 2. Not being able to stop or control worrying
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
* 3. Worrying too much about different things
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
* 4. Trouble relaxing
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
* 5. Being so restless that it is hard to sit still
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
* 6. Becoming easily annoyed or irritable
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
* 7. Feeling afraid as if something awful might happen
0 - Not at all   1 - Several days   2 - More than half the days  
3 - Nearly every day     
GAD-7 Score:
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