General Anxiety Disorder (GAD-7)
Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Not At All
Several Days
More than half the days
Nearly every day
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’s hard to sit still.
Becoming easily annoyed or irritable.
Feeling afraid as if something awful might happen
Total Score
Your Depression Severity
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? (Circle one)
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Send your results to Dr. Gupta
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