Generalized Anxiety Disorder 7-Item Scale

Name*

First Last

Email

Date

Untitled

Intended Therapist*

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

0= Not at all | 1= Several | 2= More than half the days | 3= Nearly everyday

1. Feeling nervous, anxious, or on edge

0
1
2
3

2. Not being able to stop or control worrying

0
1
2
3

3. Worrying too much about different things

0
1
2
3

4. Trouble relaxing

0
1
2
3

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

0
1
2
3

6. Becoming easily annoyed or irritable

0
1
2
3

7. Feeling afraid as if something awful might happen

0
1
2
3

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? (check one)

Not at all
Somewhat difficult
Very difficult
Extremely difficult