Generalised anxiety disorder (GAD-7) assessment

Your Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Any responses we send will go to this email address.

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

Feeling nervous, anxious, or on edge *

Not at all

Several Days

Over half the days

Nearly every day

Not being able to stop or control worrying *

Not at all

Several Days

Over half the days

Nearly every day

Worrying too much about different things *

Not at all

Several Days

Over half the days

Nearly every day

Trouble relaxing *

Not at all

Several Days

Over half the days

Nearly every day

Being so restless that it’s hard to sit still *

Not at all

Several Days

Over half the days

Nearly every day

Becoming easily annoyed or irritable *

Not at all

Several Days

Over half the days

Nearly every day

Feeling afraid as if something awful might happen *

Not at all

Several Days

Over half the days

Nearly every day

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? *

Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

*

I confirm that the information provided is accurate to the best of my knowledge

If we need to contact you to discuss anything related to your form when is the best time to contact you? *

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Generalised anxiety disorder (GAD-7) assessment

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