Please complete the below form before your next appointment. Thank you! GAD-7 Today's Date MM slash DD slash YYYY Name First Last Contact email: Generalized Anxiety Disorder 7-Item (GAD-7) FormOver the last 2 weeks, how often have you been bothered by the following problems?Feeling nervous, anxious, or on edge Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Not being able to stop or control worry Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Worry too much about different things Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Trouble relaxing Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Being so restless that it’s hard to sit still Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Becoming easily annoyed or irritable Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Feeling afraid as if something awful might happen Not sure at all – 0 Several Days – 1 Over Half the Days – 2 Nearly Every Day – 3 Staff Only: Add the score for total scoreIf you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? Please check the box next to the one that best describes the level of difficulty. Not at all difficult Somewhat difficult Very Difficult Extremely Difficult
