Pondworks Psychiatry & Psychotherapy

Generalized Anxiety Disorder Scale

Patient initials * Provider name * Date of appointment *

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

1. Feeling nervous, anxious or on edge * 2. Not being able to stop or control worrying * 3. Worrying too much about different things * 4. Trouble relaxing * 5. Being so restless that it's hard to sit still * 6. Becoming easily annoyed or irritable * 7. Feeling afraid as if something awful might happen * 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?

To Be Completed by Pondworks Staff

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