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Patient Health Questionnaire – GAD 7UHSDEV2022-11-21T13:40:25-05:00

Patient Health Questionnaire – GAD7

GAD 7

Patient Name*
First Last
Date Completed*
MM slash DD slash YYYY
Feeling nervous, anxious or on edge*
- Not at all
- Several day
- More than half the days
- Nearly every day
Not being able to stop or control worrying*
- Not at all
- Several day
- More than half the days
- Nearly every day
Worrying too much about different things*
- Not at all
- Several day
- More than half the days
- Nearly every day
Trouble relaxing*
- Not at all
- Several day
- More than half the days
- Nearly every day
Being so restless that it is hard to sit still*
- Not at all
- Several day
- More than half the days
- Nearly every day
Becoming easily annoyed or irritable*
- Not at all
- Several day
- More than half the days
- Nearly every day
Feeling afraid as if something awful might happen*
- Not at all
- Several day
- More than half the days
- Nearly every day
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*
- Not at all difficult
- Somewhat difficult
- Very difficult
- Extremely difficult
Program Type*
- PHP-5 day
- Day IOP-3 day
- Evening IOP
- Adolescent IOP

We’re Always Here to Help

Licensed mental health professionals are available 24 hours a day, 7 days a week to assist you or your loved one. To schedule a no-cost assessment or for more information, please call 407-370-0111.

Patient Health Questionnaire – GAD 7

Physicians are on the medical staff of Central Florida Behavioral Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Central Florida Behavioral Hospital. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. There are risks associated with any treatment procedure and individual results may vary. Please consult the dedicated professionals within the ECT program at Central Florida Behavioral Hospital to assess if you are a candidate for ECT treatment. Our medical staff will also consult with you on the risks and benefits of ECT treatment if you are a suitable candidate.

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