Anxiety Questionnaire (GAD-7)

Please complete this one day prior to your appointment.

Please correct the errors described below.

Client Information

First name

Last name

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

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