Adoloscent GAD Form

Generalized Anxiety Disorder Form (GAD-7)

INSTRUCTIONS: The following questions ask about thoughts, feelings, and behaviors, often tied to concerns about family, health, finances, school, and work. Please respond to each item by marking one box per row.

Patient Name*

Email Address*

Age*

Sex*

Male Female Other

Today's Date*

During the PAST 7 DAYS, I have...

1. felt moments of sudden terror, fear, or fright*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

2. felt anxious, worried, or nervous*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

3. had thoughts of bad things happening, such as family tragedy, ill health, loss of a job, or accidents*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

4. felt a racing heart, sweaty, trouble breathing, faint, or shaky*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

5. felt tense muscles, felt on edge or restless, or had trouble relaxing or trouble sleeping*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

6. avoided, or did not approach or enter, situations about which I worry*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

7. left situations early or participated only minimally due to worries*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

8. spent lots of time making decisions, putting off making decisions, or preparing for situations, due to worries*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

9. sought reassurance from others due to worries*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

10. needed help to cope with anxiety (e.g., alcohol or medication, superstitious objects, or other people)*

0 – Never 1 – Occasionally 2 – Half of the time 3 – Most of the time 4 – All of the time

Clinician Notes

Thank you for completing the GAD-7 form!

Your submission has been successfully received.