GAD-7 Anxiety Assessment Form
Please complete this form to help assess your current anxiety levels using the GAD-7 questionnaire.
Full Name
*
First Name
Last Name
Age
*
Gender
Female
Male
Non-binary
Prefer not to say
Other
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Instructions: Over the last 2 weeks, how often have you been bothered by the following problems? Please answer each item.
GAD-7 Items
*
Rows
Not at all
Several days
More than half the days
Nearly every day
Feeling nervous, anxious, or on edge
1
2
3
4
Not being able to stop or control worrying
5
6
7
8
Worrying too much about different things
9
10
11
12
Trouble relaxing
13
14
15
16
Being so restless that it's hard to sit still
17
18
19
20
Becoming easily annoyed or irritable
21
22
23
24
Feeling afraid, as if something awful might happen
25
26
27
28
If you checked any problems above, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Is there anything else you would like to share about your anxiety or mental health?
Submit Assessment
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