GAD-7 Anxiety Assessment Tool GAD-7 Client Name* First Last Birthdate* MM slash DD slash YYYY Are you experiencing symptoms of anxiety?* Yes No GAD-7 Anxiety Assessment ToolOver the past 2 weeks how often have you been bothered by any of the following problems?1. Feeling nervous, anxious or on edge.0-Not at all1. Several days2-More than half the days3-Nearly every day2. Not being able to stop or control worry0-Not at all1. Several days2-More than half the days3-Nearly every day3-Worrying too much about different things.0-Not at all1. Several days2-More than half the days3-Nearly every day4-Trouble relaxing0-Not at all1. Several days2-More than half the days3-Nearly every day5-Being so restless that it is hard to sit still0-Not at all1. Several days2-More than half the days3-Nearly every day6-Becoming easily annoyed or irritable0-Not at all1. Several days2-More than half the days3-Nearly every day7-Feeling afraid as if something awful might happen0-Not at all1. Several days2-More than half the days3-Nearly every dayIf 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 allSomewhat difficultVery difficultExtremely difficultTotal ScoreAdd up your numbers for a total scoreScoring GAD-7 Anxiety SeveritySelect your score range hereA score of 0-4 is rated as a minimal anxietyA score of 5-9 is rated as a mild anxietyA score of 10-14 is rated as a moderate anxietyA score of 15-21 is rated as a severe anxietyName of the person who provided the information for this assessment.* First Last Enter the email address given to you by your provider. Submission ID
