GAD-7 Your Name* First Last Date of Birth* MM slash DD slash YYYY Today's Date* MM slash DD slash YYYY Instructions & Acknowledgment* I understand.This questionnaire relies on self-reporting -- so answer the questions by yourself without any parental involvement. Your answers will remain confidential when you submit them to us at Kids Plus. Please select one response for each question. Over the last 2 weeks, how often have you been bothered by any of the following problems...? 1. Feeling nervous, anxious, or on-edge.* Not at all [1] Several days [2] More than half the days [3] Nearly every day 2. Not being able to stop or control worrying.* Not at all [1] Several days [2] More than half the days [3] Nearly every day 3. Worrying too much about different things.* Not at all [1] Several days [2] More than half the days [3] Nearly every day 4. Having trouble relaxing.* Not at all [1] Several days [2] More than half the days [3] Nearly every day 5. Being so restless that it's hard to sit still.* Not at all [1] Several days [2] More than half the days [3] Nearly every day 6. Becoming easily annoyed or irritable.* Not at all [1] Several days [2] More than half the days [3] Nearly every day 7. Feeling afraid as if something awful might happen.* Not at all [1] Several days [2] More than half the days [3] Nearly every day If you checked off any problem on this questionnaire so far, 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 [1] Somewhat difficult [2] Very difficult [3] Extremely difficult Thanks for completing this questionnaire. Please type your full name below and then submit the form by clicking the Submit button. By entering your name, you are acknowledging that you completed the entire form in private and without influence from a parent.* CAPTCHA
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