GAD-7 (Generalised Anxiety Disorder) Printable version GAD-7 Patient Name * Date of Birth * Who is your GP? * Mobile number to contact you * 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 More than half the days Nearly every day Not being able to stop or control worrying * Not at all Several days More than half the days Nearly every day Worrying too much about different things * Not at all Several days More than half the days Nearly every day Trouble relaxing * Not at all Several days More than half the days Nearly every day Being so restless that it is hard to sit still * Not at all Several days More than half the days Nearly every day Becoming easily annoyed or irritable * Not at all Several days More than half the days Nearly every day Feeling afraid as if something awful might happen * Not at all Several days More than half the days Nearly every day GAD-7 Score Score 0-4: Minimal Anxiety Score 5-9: Mild Anxiety Score 10-14: Moderate Anxiety Score greater than 15: Severe Anxiety 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 This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our privacy policy to discover how we protect and manage your submitted data. Consent * I agree to the privacy policy © 2006 Spitzer RL, Kroenke K, Williams JB, Löwe B. Submit If you are human, leave this field blank.