Generalized Anxiety Disorder (GAD-7)

Please answer the questions and submit the form.

Please correct the errors described below.

This form is intended to screen for current symptoms of anxiety. It will assist with initial assessment as well as track ongoing progress.

Client Information

First name

Last name

Email address

Date

Over the past 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious, or on edge?

Not at all Several days More than half the days Nearly every day

Not being able to stop or control worrying?

Not at all Several days More than half the days Nearly every day

Worrying too much about different things?

Not at all Several days More than half the days Nearly every day

Trouble relaxing?

Not at all Several days More than half the days Nearly every day

Being so restless that it's hard to sit still?

Not at all Several days More than half the days Nearly every day

Becoming easily annoyed or irritable?

Not at all Several days More than half the days Nearly every day

Feeling afraid as if something awful might happen?

Not at all Several days More than half the days Nearly every day

If you checked off any problems, how difficult have these problems 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

Your information will be encrypted.

This form is intended to screen for current symptoms of anxiety. It will assist with initial assessment as well as track ongoing progress.

Kristina Monroe, Psy.D.

Licensed Psychologist

323-546-7792
www.kristinamonroe.com
8235 Santa Monica Blvd., Suite 303, West Hollywood, CA, 90046

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