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GAD-7 Anxiety Questionnaire

PATIENT QUESTIONNAIRE

GAD-7

Over the last two weeks, how often have you been bothered by the following problems?

Patient name

Date of birth

Date completed

Instructions: For each statement, select the response that best reflects how often the problem bothered you during the last two weeks.

0 of 8 items answered

1. Feeling nervous, anxious, or on edge

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

2. Not being able to stop or control worrying

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

3. Worrying too much about different things

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

4. Trouble relaxing

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

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

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

6. Becoming easily annoyed or irritable

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

7. Feeling afraid, as if something awful might happen

0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?

1 Not difficult at all 2 Somewhat difficult 3 Very difficult 4 Extremely difficult

✓

One-button return

Complete every item, then click SEND COMPLETED FORM. A completed email addressed to Dr. Story will open.

Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission.

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