PHQ-9 GAD-7

Evergreen Youth & Family Services

Health Questionnaire / PHQ-9 & Generalized Anxiety Disorder 7 – Item (GAD-7) Scale
Name*

First NameLast Name

For each question, please answer all items best you can. Place a “0, 1, 2 or 3” in the appropriate box. Over the last 2 weeks, how often have you been bothered by any of the following problems?*

Rows	Not at all (0)	Several days (1)	More than half the days (2)	Nearly every day (3)
Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself – or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
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
Thoughts that you would be better off dead or of hurting yourself in some way

Office Use:
Not difficult at allSomewhat difficultVery difficultExtremely difficult

For each question, please answer all items best you can. Place a “0, 1, 2 or 3” in the appropriate box. Over the last 2 weeks, how often have you been bothered by any of the following problems?*

Rows	Not at all (0)	Several days (1)	More than half the days (2)	Nearly every day (3)
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’s hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as is something awful might happen

Office Use:
Not difficult at allSomewhat difficultVery difficultExtremely difficult
Should be Empty:

Evergreen Youth & Family Services