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Gad Scale Form

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Patient Details
Date of Birth
Clinician

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

Rating Scale

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 is hard to sit still?
6. Becoming easily annoyed or irritable?
7. Feeling afraid as if something awful might happen?
Clear Signature