GAD-7

Name:    Date of Birth:

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

Feeling nervous, anxious or on edge:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

Not being able to stop or control worrying:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

Worrying too much about different things:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

Trouble relaxing:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

Being so restless that it is hard to sit still:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

Becoming easily annoyed or irritable:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

Feeling afraid as if something awful might happen:

0 - Not at all1 - Several days2 - Over half the days3 - Nearly every day

If you checked off any problems from this list, how difficult have these 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