BHC - Generalized Anxiety Disorder Screener (GAD-71) - Community Choice Pediatrics

CCP Generalized Anxiety Disorder Screener (GAD 7)

Name *

First

Last

Date of Birth *

Email (for a copy of your responses)

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

Use the slider to select your response: 0 = Not at all | 1 = Several Days | 2 = More than half of the days) | 3 (Nearly All Days)

1. Feeling nervous, anxious or on edge

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

2. Not being able to stop or control worrying

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

3. Worrying too much about different things

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

4. Trouble relaxing

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

5. Being so restless that it is hard to sit still

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

6. Becoming easily annoyed or irritated

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

7. Feeling afraid as if something awful might happen

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

Total Score

8. 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?

Selected Value: 0

0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day

any Date 4.

When did the symptoms begin?

Our core values

Compassion

We place ourselves in the shoes of our patients and parents as we mindfully listen, observe, and examine judgment-free.

Collaboration

By continually sharing information and seeking the advice and opinions of each other, our patients receive the benefit of the combined knowledge, skill, and experience of all the healthcare professionals who work in the practice.

Community

A safe and healthy child makes a community stronger, and a strong community produces safe and healthy children.