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:

Not being able to stop or control worrying:

Worrying too much about different things:

Trouble relaxing:

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?

Leave this empty:

Signature arrow sign here

Signature Certificate
Document name: GAD-7
lock iconUnique Document ID: a3d2fa4bc1aa7827e8ed6a5973fbb26a49d4387b
Timestamp Audit
April 20, 2020 10:35 am PDTGAD-7 Uploaded by Do Not Reply - IP
April 29, 2020 8:23 am PDTRecords Department - added by Jason Dooley - as a CC'd Recipient Ip:
April 29, 2020 9:34 am PDTCFD Main - added by Jason Dooley - as a CC'd Recipient Ip:
March 18, 2021 2:05 pm PDT Document owner has handed over this document to 2021-03-18 14:05:29 -
March 18, 2021 2:05 pm PDTCFD Main - added by Do Not Reply - as a CC'd Recipient Ip: