Anxiety Depression Rating Scale
GAD-7
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Patient Name
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First Name
Last Name
Date of Birth
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When doing this form please think about:
Over the Last 2 weeks, How often have you been bothered by the following problems?
Feeling nervous, anxious or on edge?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Not being able to stop or control worrying?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Worrying too much about different things?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Trouble Relaxing?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Being so restless that it's hard to sit still?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Becoming easily annoyed or irritable?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Feeling afraid as if something awful might happen?
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0-Not at all sure
1-Several Days
2-Over half the days
3-Nearly every day
Submit
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