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HOME
ABOUT
FEES
SERVICES
CONTACT
RESOURCES
FORMS
Adult Registration Intake Form
Child Registration Form
Patient Health Questionnaire Form (PHQ-9)
General Anxiety Disorder (GAD-7)
Adult ADHD Self-Report Scale Form
Couple’s Counseling Intake Form
Good Faith Estimate for Services
Release of Information Form
Tele Mental Health Informed Consent
Client Consent to Allow PHI by Email or Text Message
General Anxiety Disorder Form
(GAD-7)
Please complete this form to the best of your ability.
General Anxiety Disorder (GAD-7)
Trinity Psych Wellness
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Please select your answers by clicking on the circle.
First Name
Last Name
Email
Today's Date
Date of Birth (Day/Month/year)
1. Feeling nervous, anxious, or on edge.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
2. Not being able to stop or control worrying.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
3. Worrying too much about different things.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
4. Trouble relaxing.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
5. Being so restless that it’s hard to sit still.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
6. Becoming easily annoyed or irritable.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
7. Feeling afraid as if something awful might happen.
Not at all
Several Days
More Than Half The Days
Nearly Every Day
If you checked off any problems above, indicate how difficult have these made it for you to do your work, take care of things at home, or get along with other people? Click the button that applies.
Not difficult at all
Somewhat difficult
Very Difficult
Extremely difficult
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