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:
Worrying too much about different things:
Being so restless that it is hard to sit still:
Becoming easily annoyed or irritable:
Feeling afraid as if something awful might happen:
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
Leave this empty:
Your legal name
Your email address
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Document Name: GAD-7
Agree & Sign