Please read each statement and record a number 0, 1, 2 or 3 to indicate how much the statement has applied to you over the past two weeks. There are no right or wrong answers. Just tally your score on a piece of paper.
This assessment is not intended to be a diagnosis. If you are concerned about your results in any way, please speak with a qualified health professional.
0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day
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 (something awful might happen)
Scoring Guide: Normal 0 ‐ 4, Mild 5 ‐ 9, Moderate 10 ‐ 14, Severe 15 ‐ 21
If your score is ten or greater, please consult with a qualified health professional.
Privacy Statement: this form neither saves nor transmits any information about you or your assessment scores. These results are intended as a guide to your health and are not intended to be a clinical diagnosis.