David Howard
| Psychologist
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GAD-7 Questionnaire
GAD-7
My Name:
Street Address:
Phone Number:
Email Address:
Date:
Over the last two weeks, how often have you been bothered by any of the following?
1
Feeling nervous, anxious, or on edge
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
2
Not being able to stop or control worrying
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
3
Worrying too much about different things
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
4
Trouble relaxing
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
5
Being so restless that it's hard to sit still
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
6
Becoming easily annoyed or irritable
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
7
Feeling afraid as if something awful might happen
Please select a value ...
Not at all
Several Days
More than half the days
Nearly every day
8
If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?
Please select a value ...
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
