Generalised Anxiety Disorder Assessment

If you have been advised by the surgery to submit a Generalised Anxiety Disorder Assessment, please use this form.

If you are completing this as part of an Urgent Care Appointment assessment, please ensure that you make a note of your score to inform the clinician you see today. Please also ensure you tick the box that indicates it is for an UC appointment.

Generalised Anxiety Disorder Assessment

Patient Details

Please use this date format: DD/MM/YYYY

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

Feeling nervous, anxious or on edge?
Not being able to stop or control worrying?
Worrying too much about different things?
Trouble relaxing?
Being so restless that it is hard to sit still?
Becoming easily annoyed or irritable?
Feeling afraid as if something awful might happen?
Score Result
0-5 Normal
5-9 Mild Anxiety
10-14 Moderate Anxiety
15+ Severe Anxiety