GAD Studies

Personal Information

First Name *

Last Name *

Phone Number *

Email *

Date of Birth MM/DD/YYYY *

Zip Code *

What sex were you assigned at birth? *

Health History

Have you been diagnosed by a doctor with Generalized Anxiety Disorder (GAD)? *

Do you experience any of the symptoms listed below? *
Please select all that apply…

Difficulty controlling feelings of worry

Feeling restless / wound-up / on edge

Difficulty concentrating

Fatigue

Irritability

Trouble falling asleep or staying asleep

Headaches / muscle aches / stomach aches

Other symptoms of Anxiety

None of the above

Have you been diagnosed (by a doctor) with any of the additional psychiatric medical conditions? *

Schizophrenia

Bipolar disorder

Obsessive Compulsive Disorder (OCD)

Borderline or antisocial personality disorder (BPD)

None of the above

Do you have a history of drug or alcohol abuse within the past 6 months? *

Have you been diagnosed (by a doctor) with any other medical conditions? *
(For example: Neurocognitive disorder, major depressive disorder (MDD), autism spectrum disorder (ASD), attention-deficit/hyperactive disorder (ADHD), dyslexia, cerebral palsy, cyclothymic disorder, neuroleptic malignant syndrome, serotonin syndrome, pituitary tumor, HIV, type 1 diabetes, schizophrenia, schizoaffective disorder, schizophreniform disorder, bipolar disorder, HIV, hepatitis B, hepatitis C, cancer, significant head injury, CNS tumor, epilepsy, dementia, amnestic or central sleep apnea)
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

What medically approved treatments are you currently taking for your Generalized Anxiety Disorder (GAD)? *
Please select all that apply.

Paroxetine (Paxil®)

Venlafaxine XR (Effexor®)

Duloxetine (Cymbalta®)

Escitalopram (Lexapro®/ Cipralex®)

Buspirone (BuSpar®)

Other

None of the above

How many medications have you tried taking for your Generalized Anxiety Disorder (GAD) *
Please enter a number below

Have you seen a significant improvement in your GAD symptoms with the two or more medications you have tried? *
Please note: Symptoms of GAD include restlessness, persistent worrying and overthinking, feeling on edge or irritable, difficulty concentrating, fatigue, trouble sleeping, shortness of breath, heart palpitations muscle tension or muscle aches.

Are you taking any additional medications or treatments for your GAD or other health conditions? *
(Examples include: Lexapro, Adderall, Lorazepam, Prozac, Sertraline, Propranolol, Escitalopram, Vagus Nerve Stimulation, Transcranial Magnetic Stimulation (TMS), Neuromodulation, Electroconvulsive therapy (ECT), Ketamine, Esketamine, Arketamine, Psilocybin, MDMA,)
Please list them below or type 'none'.

Have you previously had an allergic reaction to a medication? *

Additional Details

Are you struggling with symptoms of Generalized Anxiety Disorder?

Are you interested in participating in research studies for potential new treatment for GAD?

What happens if I fill out the questionnaire?

Complete a short survey to see if you may qualify