GAD-7 Form

Please complete all information required in the form fields below

GAD-7

Full Name *

Date of Birth *

Address
Address Line 1
City
State / Province / Region
Postal Code
This service is only available within South Australia. Check our services page for specific locations. Or contact Head to Health directly on 1800 595 212 or visit website www.headtohealth.gov.au for alternative services in their area.

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

Not at all Several Days More than half the days Nearly every day

Feeling nervous, anxious or on edge
Not at allFeeling nervous, anxious or on edge Not at all
Several DaysFeeling nervous, anxious or on edge Several Days
More than half the daysFeeling nervous, anxious or on edge More than half the days
Nearly every dayFeeling nervous, anxious or on edge Nearly every day
Not being able to stop or control worrying
Not at allNot being able to stop or control worrying Not at all
Several DaysNot being able to stop or control worrying Several Days
More than half the daysNot being able to stop or control worrying More than half the days
Nearly every dayNot being able to stop or control worrying Nearly every day
Worrying too much about different things
Not at allWorrying too much about different things Not at all
Several DaysWorrying too much about different things Several Days
More than half the daysWorrying too much about different things More than half the days
Nearly every dayWorrying too much about different things Nearly every day
Trouble relaxing
Not at allTrouble relaxing Not at all
Several DaysTrouble relaxing Several Days
More than half the daysTrouble relaxing More than half the days
Nearly every dayTrouble relaxing Nearly every day
Being so restless that it is hard to sit still
Not at allBeing so restless that it is hard to sit still Not at all
Several DaysBeing so restless that it is hard to sit still Several Days
More than half the daysBeing so restless that it is hard to sit still More than half the days
Nearly every dayBeing so restless that it is hard to sit still Nearly every day
Becoming easily annoyed or irritable
Not at allBecoming easily annoyed or irritable Not at all
Several DaysBecoming easily annoyed or irritable Several Days
More than half the daysBecoming easily annoyed or irritable More than half the days
Nearly every dayBecoming easily annoyed or irritable Nearly every day
Feeling afraid as if something awful might happen
Not at allFeeling afraid as if something awful might happen Not at all
Several DaysFeeling afraid as if something awful might happen Several Days
More than half the daysFeeling afraid as if something awful might happen More than half the days
Nearly every dayFeeling afraid as if something awful might happen Nearly every day

	Not at all	Several Days	More than half the days	Nearly every day
Feeling nervous, anxious or on edge	Not at allFeeling nervous, anxious or on edge Not at all	Several DaysFeeling nervous, anxious or on edge Several Days	More than half the daysFeeling nervous, anxious or on edge More than half the days	Nearly every dayFeeling nervous, anxious or on edge Nearly every day
Not being able to stop or control worrying	Not at allNot being able to stop or control worrying Not at all	Several DaysNot being able to stop or control worrying Several Days	More than half the daysNot being able to stop or control worrying More than half the days	Nearly every dayNot being able to stop or control worrying Nearly every day
Worrying too much about different things	Not at allWorrying too much about different things Not at all	Several DaysWorrying too much about different things Several Days	More than half the daysWorrying too much about different things More than half the days	Nearly every dayWorrying too much about different things Nearly every day
Trouble relaxing	Not at allTrouble relaxing Not at all	Several DaysTrouble relaxing Several Days	More than half the daysTrouble relaxing More than half the days	Nearly every dayTrouble relaxing Nearly every day
Being so restless that it is hard to sit still	Not at allBeing so restless that it is hard to sit still Not at all	Several DaysBeing so restless that it is hard to sit still Several Days	More than half the daysBeing so restless that it is hard to sit still More than half the days	Nearly every dayBeing so restless that it is hard to sit still Nearly every day
Becoming easily annoyed or irritable	Not at allBecoming easily annoyed or irritable Not at all	Several DaysBecoming easily annoyed or irritable Several Days	More than half the daysBecoming easily annoyed or irritable More than half the days	Nearly every dayBecoming easily annoyed or irritable Nearly every day
Feeling afraid as if something awful might happen	Not at allFeeling afraid as if something awful might happen Not at all	Several DaysFeeling afraid as if something awful might happen Several Days	More than half the daysFeeling afraid as if something awful might happen More than half the days	Nearly every dayFeeling afraid as if something awful might happen Nearly every day

Date

Comment