Anxiety Screening

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Name
Date of Birth:
Date:

Over the last two weeks, how often have you been bothered by the following problems?

TOTALS:

TOTAL:: 0
TOTAL:: 0
TOTAL:: 0
TOTAL:: 0
Add the previous four totals together to get your overall score

Difficulties?

Scoring GAD-7 Anxiety Severity This is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of "not at all," "several days," "more than half the days," and "nearly every day." GAD-7 total score for the seven items ranges from 0 to 21.

Results:

Results:
Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues.

For research information, contact Dr. Spitzer at ris8(columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved.
Reproduced with permission