Loading...

Templates › Surveys › SEO page

Run: GAD-7 Anxiety Screening

GAD-7 Anxiety Screening template for intake and follow-up visits. Capture the 7 validated anxiety items, functional impairment, and clinician scoring in one ...

Fill this out, get a PDF emailed to you. No account required. Want to run it with your team and track results? Sign up free →

Instructions

Assessment Period (required)

Select the visit type for this administration of the GAD-7.

Over the last two weeks, how often have you been bothered by the following problems? Please read each item carefully before selecting your response.

Response options for all items below: 0 = Not at all | 1 = Several days | 2 = More than half the days | 3 = Nearly every day. This instruction is displayed to the respondent before the symptom items.

GAD-7 Symptom Items (Past 2 Weeks)

1. Feeling nervous, anxious, or on edge (required)

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 (required)

0 = Not at all | 1 = Several days | 2 = More than half the days | 3 = Nearly every day

3. Worrying too much about different things (required)

0 = Not at all | 1 = Several days | 2 = More than half the days | 3 = Nearly every day

4. Trouble relaxing (required)

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 (required)

0 = Not at all | 1 = Several days | 2 = More than half the days | 3 = Nearly every day

6. Becoming easily annoyed or irritable (required)

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 (required)

0 = Not at all | 1 = Several days | 2 = More than half the days | 3 = Nearly every day

Functional Impairment

If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? (required)

Options: Not difficult at all | Somewhat difficult | Very difficult | Extremely difficult. This item is part of the standard GAD-7 administration and assesses functional impact but is not included in the 0–21 total score.

Scoring & Clinical Interpretation

GAD-7 Total Score (0–21) — Clinician Calculated

Sum of items 1–7. Severity bands: 0–4 = Minimal anxiety | 5–9 = Mild anxiety | 10–14 = Moderate anxiety | 15–21 = Severe anxiety. Scores ≥10 warrant further evaluation (Spitzer et al., 2006, Archives of Internal Medicine).

Severity Band

Select the severity classification based on the total score above.

Change from Previous Score (if follow-up visit)

Enter the difference from the prior GAD-7 total score (positive = worsening; negative = improvement). A change of ≥5 points is considered a clinically meaningful difference.

Clinical Notes & Follow-Up

Clinician Observations and Context

Document any relevant clinical context, patient-reported triggers, comorbid conditions, or behavioral observations that may affect score interpretation.

Recommended Next Steps

Document clinical recommendations based on score (e.g., watchful waiting, psychoeducation, CBT referral, medication evaluation, crisis protocol). For scores ≥15, document safety assessment and escalation plan.

Is there anything else you would like to share about how you have been feeling?

Open-ended space for the respondent to provide additional context not captured by the structured items.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Generated with MangoApps Templates — browse 250+ free