Generalized Anxiety Disorder 7-Item (GAD-7) Scale Coach Name(Required) Coach's Phone Number(Required)Coach's Email(Required) Name(Required) First Date(Required) YYYY slash MM slash DD Client Phone(Required)Client Email(Required) Over the last 2 weeks, how often have you been bothered by the following problems? 1. Feeling nervous, anxious, or on edge Not at all Several days Over half the days Nearly every day 2. Not being able to stop or control worrying Not at all Several days Over half the days Nearly every day 3. Worrying too much about different things Not at all Several days Over half the days Nearly every day 4. Trouble relaxing Not at all Several days Over half the days Nearly every day 5. Being so restless that it’s hard to sit still Not at all Several days Over half the days Nearly every day 6. Becoming easily annoyed or irritable Not at all Several days Over half the days Nearly every day 7. Feeling afraid as if something awful might happen Not at all Several days Over half the days Nearly every day TotalIf any of the above problems were identified, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? Untitled Not difficult at all Somewhat difficult Very difficult Extremely difficult GAD-7 Important Notes and Scoring The GAD-7 is based on the diagnostic criteria for GAD described in DSM-IV. However, the GAD-7 is also sensitive to severity of symptoms of social phobia, post-traumatic stress disorder, and panic disorder. Please note: This questionnaire is designed for use by a health professional. Since the questionnaires rely on patient self-report, all responses should be verified by the clinician and a definitive diagnosis made on clinical grounds, taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient (e.g., presence of DSM-IV GAD symptoms). A diagnosis of Generalized Anxiety Disorder should not be made based on GAD-7 scores alone. A score of 10 or greater indicates that further evaluation is required. The scores are as follows: 0-4 Minimal Anxiety 5-9 Mild Anxiety 10-14 Moderate Anxiety 15-21 Severe Anxiety PhoneThis field is for validation purposes and should be left unchanged. Δ
