Trauma Informed Counselling
GAD-7 Assessment 2026

GAD-7 Anxiety Assessment

Generalized Anxiety Disorder 7-Item Scale — Data entry form

1. Client Details

Client full name *

Date of birth *

Age (auto)

Assessment date

Clinician

Client / File ID (optional)

2. GAD-7 Responses

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

0 = Not at all · 1 = Several days · 2 = More than half the days · 3 = Nearly every day

Total Score

out of 21

Severity Band

Minimal

None to minimal anxiety symptoms

3. Functional Impact

If you checked any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

4. Clinician Notes (optional)

5. Client Sign-off (Digital)

Type your name and draw your signature below to confirm the answers are accurate.

Client full name (sign-off) *

Date of sign-off

Signature *

Your name will appear in a signature-style script font.

(enter name above)

Upload a clear image of your signature (PNG or JPG).

I confirm the information I have provided is true and complete, and that the signature above is mine.
On save, a digital integrity seal is applied so Elena can verify the data has not been altered.

By submitting this form you agree to our handling of your information as described in our Confidentiality & Service Agreement. Your responses are used for clinical care and practice administration only.

Age, Total Score and Severity update automatically.
Clients: complete the form, then click Submit to My Health + Mental Wellbeing. We receive it by email automatically — no file to send.
Clinician / Elena: use “Save encrypted copy” only if you need a passphrase-protected file.