Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPatient Health Questionnaire cont. (GAD-7): Please Slide The Scales And Answer The Questions Using The Scoring SystemOver The Last Two Weeks, How Often Have You Been Bothered By Any Of The Following Problems? 0 = Not At All, 1 = Several Days, 2 = More Than Half The Days, 3 = Nearly Every DayFeeling Nervous, Anxious, or On Edge Selected Value: 0 Not Being Able To Stop or Control Worrying Selected Value: 0 Worrying Too Much About Different Things Selected Value: 0 Trouble Relaxing Selected Value: 0 Feeling Get Different Being So Restless You Can't Sit Still Selected Value: 0 Becoming Easily Annoyed or Irritable Selected Value: 0 Feeling Afraid As If Something Awful Might Happen Selected Value: 0 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? *--- Select Choice ---Not Difficult At AllSomewhat DifficultVery DifficultExtremely Difficult By Submitting This Form I Acknowledge the Information Provided is Accurate and Truthful, To The Best Of My Knowledge *YesFOR OFFICE USE ONLY: PATIENT GAD-7 SCORESubmit
