| These questions are to ask you about things you may have felt most days in the past six months. | Yes | No |
|---|---|---|
| 1. Most days I feel very nervous. | ||
| 2. Most days I worry about lots of things. | ||
| 3. Most days I cannot stop worrying. | ||
| 4. Most days my worry is hard to control. | ||
| 5. I feel restless, keyed up or on edge. | ||
| 6. I get tired easily. | ||
| 7. I have trouble concentrating. | ||
| 8. I am annoyed or irritated. | ||
| 9. My muscles are tense and tight. | ||
| 10. I have trouble sleeping. | ||
| 11. Did the things you noted above affect your daily life (home life, or work, or leisure) or cause you a lot of distress? | ||
| 12. Were the things you noted above bad enough that you thought about getting help for them? | ||
| Total |
Score of 0-5: Symptoms not suggestive of Generalized Anxiety Disorder.
Score of 6 or above: Symptoms suggestive of Generalized Anxiety Disorder. A complete evaluation is recommended.
Note: This questionnaire is provided for educational purposes only. It is not a substitute for consulting with a health professional. Even if an individual’s score on the questionnaire is “negative,” it is very important to consult with a primary care doctor or a mental health professional if there are concerns.
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September 13, 2019