GAD-7 - Anxiety Assessment

Anxiety Screening Questionnaire — Past 2 Weeks

Patient name

Date

DOB

MRN

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

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

Functional Impact

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

Scoring

Total GAD-7 Score:	/ 21
0–4:	Minimal anxiety
5–9:	Mild anxiety
10–14:	Moderate anxiety
15–21:	Severe anxiety

Clinical note: The GAD-7 is a screening and symptom-severity measure. Interpret results together with clinical assessment and other relevant information; a score of 10 or greater commonly warrants further evaluation for an anxiety disorder.

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Follow-up/Notes