GAD7 and PHQ9

Anxiety and Depression Screening

Make the best of your clinical time by filling this out before your appointment
Today's Date *

Month Day Year
Date
Name

First Name Last Name
These questions are standard screening assessments used in offices across the country to screen for for depression and anxiety.

It is common to find it difficult to choose an answer, as there isn't room for nuance. That's OK! Just pick the answer that feels closest to the truth, even if it's approximate or you don't fully understand the question.
Over the last two weeks, how much have you been bothered by any of the following problems?
Feeling nervous, anxious or on edge?

Not at all Several days More than half the days Nearly every day
Not being able to stop or control worrying?

Not at all Several days More than half the days Nearly every day
Worrying too much about different things?

Not at all Several days More than half the days Nearly every day
Trouble relaxing?

Not at all Several days More than half the days Nearly every day
Being so restless that it is hard to sit still?

Not at all Several days More than half the days Nearly every day
Becoming easily annoyed or irritable

Not at all Several days More than half the days Nearly every day
Feeling afraid as if something awful might happen

Not at all Several days More than half the days Nearly every day
Little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day
Feeling down, depressed or hopeless?

Not at all Several days More than half the days Nearly every day
Trouble falling asleep, staying asleep, or sleeping too much?

Not at all Several days More than half the days Nearly every day
Feeling tired or having little energy?

Not at all Several days More than half the days Nearly every day
Poor appetite or overeating?

Not at all Several days More than half the days Nearly every day
Feeling bad about yourself, or that you're a failure or have let yourself or your family down?

Not at all Several days More than half the days Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television?

Not at all Several days More than half the days Nearly every day
Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual?

Not at all Several days More than half the days Nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way?

Not at all Several days More than half the days Nearly every day
List one new life issue, or the most stressful aspect of your current life (ie work, child rearing, finances)
How problematic or distressing have the above symptoms been overall?

Not at all A little distressing or problematic Moderately distressing or problematic Very distressing or problematic
Anxiety score (utilizing the GAD7 psychometric)
Depression score (utilizing the PHQ9 psychometric)
Should be Empty:

Anxiety and Depression Screening