Generalized Anxiety Disorder Assessment-Adult Self Report

Assessment 1 of 14

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. During the PAST 7 DAYS, I have felt moments of sudden terror, fear, or fright
2. During the PAST 7 DAYS, I have felt anxious, worried, or nervous
3. During the PAST 7 DAYS, I have had thoughts of bad things happening, such as family tragedy, ill health, loss of a job, or accidents
4. During the PAST 7 DAYS, I have felt a racing heart, sweaty, trouble breathing, faint, or shaky
5. During the PAST 7 DAYS, I have felt tense muscles, felt on edge or restless, or had trouble relaxing or trouble sleeping
6. During the PAST 7 DAYS, I have avoided, or did not approach or enter, situations about which I worry
7. During the PAST 7 DAYS, I have left situations early or participated only minimally due to worries
8. During the PAST 7 DAYS, I have left situations early or participated only minimally due to worries
9. During the PAST 7 DAYS, I have spent lots of time making decisions, putting off making decisions, or preparing for situations, due to worries
10. During the PAST 7 DAYS, I have sought reassurance from others due to worries
11. During the PAST 7 DAYS, I have needed help to cope with anxiety (e.g., alcohol or medication, superstitious objects, or other people)