GAD-7 Health Questionnaire
GAD-7 Health Questionnaire
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Over the last two weeks, how often have you been bothered by the following problems?
*
Rows
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
1. Feeling nervous
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it's hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen
.
*
Rows
Not at all
0
Several days
1
Over half the days
2
Nearly every day
3
Add the score for each column
TOTAL SCORE
*
.
*
Rows
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?
Submit
Should be Empty: