Licensed GA Counselor Since 1991

Generalized Anxiety Disorder Questionnaire

Client's Name *

First

Last

Client's Birthday *

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
1. Feeling nervous, anxious, or on edge	Not at all1. Feeling nervous, anxious, or on edge Not at all	Several days1. Feeling nervous, anxious, or on edge Several days	More than half the days1. Feeling nervous, anxious, or on edge More than half the days	Nearly every day1. Feeling nervous, anxious, or on edge Nearly every day
2. Not being able to stop or control worrying	Not at all2. Not being able to stop or control worrying Not at all	Several days2. Not being able to stop or control worrying Several days	More than half the days2. Not being able to stop or control worrying More than half the days	Nearly every day2. Not being able to stop or control worrying Nearly every day
3. Worrying too much about different things	Not at all3. Worrying too much about different things Not at all	Several days3. Worrying too much about different things Several days	More than half the days3. Worrying too much about different things More than half the days	Nearly every day3. Worrying too much about different things Nearly every day
4. Trouble relaxing	Not at all4. Trouble relaxing Not at all	Several days4. Trouble relaxing Several days	More than half the days4. Trouble relaxing More than half the days	Nearly every day4. Trouble relaxing Nearly every day
5. Being so restless that it is hard to sit still	Not at all5. Being so restless that it is hard to sit still Not at all	Several days5. Being so restless that it is hard to sit still Several days	More than half the days5. Being so restless that it is hard to sit still More than half the days	Nearly every day5. Being so restless that it is hard to sit still Nearly every day
6. Becoming easily annoyed or irritated	Not at all6. Becoming easily annoyed or irritated Not at all	Several days6. Becoming easily annoyed or irritated Several days	More than half the days6. Becoming easily annoyed or irritated More than half the days	Nearly every day6. Becoming easily annoyed or irritated Nearly every day
7. Feeling afraid as if something awful might happen	Not at all7. Feeling afraid as if something awful might happen Not at all	Several days7. Feeling afraid as if something awful might happen Several days	More than half the days7. Feeling afraid as if something awful might happen More than half the days	Nearly every day7. Feeling afraid as if something awful might happen 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 difficult at all	Somewhat difficult	Very difficult	Extremely difficult
Not difficult at allItem #1 Not difficult at all	Somewhat difficultItem #1 Somewhat difficult	Very difficultItem #1 Very difficult	Extremely difficultItem #1 Extremely difficult

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Generalized Anxiety Disorder Questionnaire