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PHQ-2 & PHQ-9
GAD-2 & GAD-7
OPIOID RISK TOOL
PATIENT CONTRACT
CPT 96127

Generalized Anxiety Disorder Questionnaire

GAD-2 and GAD-7

The GAD-2 is used as an initial screen for GAD. Depending on your answers, you may be asked to complete the GAD-7, which includes 5 additional questions.

GAD-2
GAD-7

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

1.  Feeling nervous, anxious, or on edge

2.  Not being able to stop or control worrying

No further screening necessary
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More screening is needed to understand your answers. Please complete the following 7 questions.

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

Complete Questionnaire
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Your score of  0 indicates that you may have
If you are taking this at the request of your doctor, please address these results with your provider.
If you are taking this on your own, learn more about next steps here.
Review and print
PRINT PREVIEW
The following patient completed the GAD screen on xx/xx/xxxx. at xx:xx local time. CPT 96127

Screening for Generalized Anxiety (GAD-7)

Result:   -

Patient Name:

DOB:

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1. Feeling nervous, anxious, or on edge
N/A   
2.  Not being able to stop or control worrying
N/A
3. Worrying too much about different things
N/A 
4. Trouble relaxing
N/A 
5. Being so restless that it is hard to sit still
N/A
6. Becoming easily annoyed or irritable
N/A  
7. Feeling afraid as if something awful might happen
N/A