Generalized Anxiety Disorder Screener (GAD-7)
Please answer these questions before your visit.
Name
*
First Name
Last Name
Visit date
*
-
Month
-
Day
Year
Over the last 2 weeks, how often have you been bothered by 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 is hard to sit still.
Becoming easily annoyed or irritated.
Feeling afraid as if something awful might happen.
Score
You can discuss your score with your doctor.
How difficult have the problems you experienced 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
When did the symptoms you experienced begin?
Back
Next
Have there been any changes to your medications?
No
Yes
Please describe the medication changes.
If you are filling out more than one questionnaire, you only need to do this part once.
Do you have access to your Patient Portal account?
Yes
No
I don't know
Please provide your email address so we can set-up your Patient Portal account. If you don't have an email address, just leave the space blank.
example@example.com
Signature
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