Generalized Anxiety Disorder Assesment (GAD-7)

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First Name*

Last Name*

Phone Number*

Email Address*

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

1. Feeling nervous, anxious, or on edge*

2. Not being able to stop or control worrying*

3. Worrying too much about different things*

4. Trouble relaxing*

5. Being so restless that it is hard to sit still*

6. Becoming easily annoyed or irritable*

7. Feeling afraid, as if something awful might happen*

Using the numbers of your answers, please enter your total score.*

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?*

_{Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For
research information, contact Dr. Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved.}

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