GAD-7

First Name *

Last Name *

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious, or on edge *

Not at allSeveral daysMore than half the daysNearly every day

Not being able to stop or control worrying *

Not at allSeveral daysMore than half the daysNearly every day

Worrying too much about different things *

Not at allSeveral daysMore than half the daysNearly every day

Trouble relaxing *

Not at allSeveral daysMore than half the daysNearly every day

Being so restless that it is hard to sit still *

Not at allSeveral daysMore than half the daysNearly every day

Becoming easily annoyed or irritable *

Not at allSeveral daysMore than half the daysNearly every day

Feeling afraid, as if something awful might happen *

Not at allSeveral daysMore than half the daysNearly every day

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

Not difficult at allSomewhat difficultVery difficultExtremely difficult

Total Score