PHQ-9 & GAD-7

Name*

First NameLast Name

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

0- Not at all

1- Several days

2- More than half of the days

3- Nearly every day

1. Little interest or pleasure in doing things

0123

2. Feeling down depressed or hopeless

0123

3. Trouble falling or staying asleep, or sleeping too much

0123

4. Feeling tired or having little energy

0123

5. Poor appetite or over eating

0123

6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down

0123

7. Trouble concentrating on things, such as reading the newspaper or watching television

0123

8. Moving or speaking so slowly that people could have noticed or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.

0123

9. Thoughts that you would be better off dead or hurting yourself in some way

0123

PHQ9 - Total Score

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

1. Feeling nervous, anxious or on edge

0123

2. Not being able to stop or control worrying

0123

3. Worrying too much about different things

0123

4. Trouble relaxing

0123

5. Being so restless it is hard to sit still

0123

6. Becoming easily annoyed or irritable

0123

7. Feeling afraid as if something awful might happen

0123

GAD7 - Total Score