Generalized Anxiety Disorder 7-item (GAD-7) scale

Name Name * First Last
Account Number *
Provider

Over the last 2 weeks, how often have you been
bothered by the following problems?
	Not at all (0)	Several days (1)	Over half the days (2)	Nearly every day (3)
Feeling nervous, anxious, or on edge	Feeling nervous, anxious, or on edgeNot at all (0)	Feeling nervous, anxious, or on edgeSeveral days (1)	Feeling nervous, anxious, or on edgeOver half the days (2)	Feeling nervous, anxious, or on edgeNearly every day (3)
Not being able to stop or control worrying	Not being able to stop or control worryingNot at all (0)	Not being able to stop or control worryingSeveral days (1)	Not being able to stop or control worryingOver half the days (2)	Not being able to stop or control worryingNearly every day (3)
Worrying too much about different things	Worrying too much about different thingsNot at all (0)	Worrying too much about different thingsSeveral days (1)	Worrying too much about different thingsOver half the days (2)	Worrying too much about different thingsNearly every day (3)
Trouble relaxing	Trouble relaxingNot at all (0)	Trouble relaxingSeveral days (1)	Trouble relaxingOver half the days (2)	Trouble relaxingNearly every day (3)
Being so restless that it's hard to sit still	Being so restless that it's hard to sit stillNot at all (0)	Being so restless that it's hard to sit stillSeveral days (1)	Being so restless that it's hard to sit stillOver half the days (2)	Being so restless that it's hard to sit stillNearly every day (3)
Becoming easily annoyed or irritable	Becoming easily annoyed or irritableNot at all (0)	Becoming easily annoyed or irritableSeveral days (1)	Becoming easily annoyed or irritableOver half the days (2)	Becoming easily annoyed or irritableNearly every day (3)
Feeling afraid as if something awful might happen	Feeling afraid as if something awful might happenNot at all (0)	Feeling afraid as if something awful might happenSeveral days (1)	Feeling afraid as if something awful might happenOver half the days (2)	Feeling afraid as if something awful might happenNearly every day (3)

How difficult have these problems made it to do work, take care of things at home, or get along with other people? *

How difficult have these problems made it to do work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult

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