Northland Counseling Center

Committed to Recovery

GAD-7

Thank you for choosing Northland Counseling Center, Inc! Please complete the below form as part of our intake process or for our annual update. Any missing information may cause a delay in services. Along with this form please ensure you are also filling out these additional forms:

GAD-7

MM slash DD slash YYYY
Name

Generalized Anxiety Disorder 7-Item (GAD-7) Form

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 worry
Worry too much about different things
Trouble relaxing
Being so restless that it’s hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
If 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.