Patient Health Questionnaire-9 (Phq-9) Template/form Gad-7 Page 2
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8GAD-7
More than
Over the last 2 weeks, how often have you
Not
Several
Nearly
half the
been bothered by the following problems?
at all
days
every day
days
✔
(Use “
” to indicate your answer)
1. Feeling nervous, anxious or on edge
0
1
2
3
2. Not being able to stop or control worrying
0
1
2
3
3. Worrying too much about different things
0
1
2
3
4. Trouble relaxing
0
1
2
3
5. Being so restless that it is hard to sit still
0
1
2
3
6. Becoming easily annoyed or irritable
0
1
2
3
7. Feeling afraid as if something awful
0
1
2
3
might happen
(For office coding: Total Score T____ = ____
+ ____
+
____ )
Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an
educational grant from Pfizer Inc.
No permission required to reproduce, translate, display or distribute.
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