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Questionnaire template

Anxiety Screening (GAD-7)

Screens adults for anxiety symptoms over the last two weeks with the GAD-7, plus daily impact and support needs.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

How You Have Been Feeling

  1. Thank you for completing this short check. It asks about feelings of worry and tension over the past two weeks, and your answers are confidential.

  2. This screen uses the Generalized Anxiety Disorder 7-item scale (GAD-7), developed by Drs. Robert L. Spitzer, Kurt Kroenke, Janet B. W. Williams and Bernd Löwe. It is free to use without permission.

  3. Your result is a screening aid, not a diagnosis. Please discuss it with a health professional.

  4. Over the last 2 weeks, how often have you been bothered by the following problems?

    • Feeling nervous, anxious, or on edge
    • Not being able to stop or control worrying
    • Worrying too much about different things
    • Trouble relaxing
    • Being so restless that it is hard to sit still
    • Becoming easily annoyed or irritable
    • Feeling afraid, as if something awful might happen

    For each row: choose one:

    • Not at all
    • Several days
    • More than half the days
    • Nearly every day

Impact on Daily Life

  1. 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?

    Choose one:

    • Not difficult at all
    • Somewhat difficult
    • Very difficult
    • Extremely difficult

Support and Next Steps

  1. Are you currently getting any professional help for worry or anxiety?

    Choose one:

    • Yes
    • No
    • Prefer not to say

  2. Would you like someone from your care team to contact you about support options?

    Choose one:

    • Yes
    • No

  3. Which age group are you in?

    Choose one:

    • 18-24
    • 25-34
    • 35-44
    • 45-54
    • 55-64
    • 65 or older