PHQ-9 GAD-7

PHQ-9 GAD-7

Health Questionnaire
Legal Name

First NameLast Name
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things*

Not at allSeveral daysMore than half the daysNearly every day
Feeling down, depressed, or hopeless*

Not at allSeveral daysMore than half the daysNearly every day
Trouble falling or staying asleep, or sleeping too much*

Not at allSeveral daysMore than half the daysNearly every day
Feeling tired or having little energy*

Not at allSeveral daysMore than half the daysNearly every day
Poor appetite or overeating*

Not at allSeveral daysMore than half the daysNearly every day
Feeling bad about yourself--or that you are a failure or have let yourself or your family down*

Not at allSeveral daysMore than half the daysNearly every day
Trouble concentrating on things, such as reading the newspaper or watching television*

Not at allSeveral daysMore than half the daysNearly 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 allSeveral daysMore than half the daysNearly every day
Thoughts that you would be better off dead or of hurting yourself in some way*

Not at allSeveral daysMore than half the daysNearly every day
Feeling nervous, anxious or on edge?*

Not at allSeveral daysMore than half the daysNearly every day
Not being able to stop or control worrying?*

Not at allSeveral daysMore than half the daysNearly every day
Worrying too much about different things?*

Not at allSeveral daysMore than half the daysNearly every day
Trouble relaxing?*

Not at allSeveral daysMore than half the daysNearly every day
Being so restless that it is hard to sit still?*

Not at allSeveral daysMore than half the daysNearly every day
Becoming easily annoyed or irritable?*

Not at allSeveral daysMore than half the daysNearly every day
Feeling afraid as if something awful might happen?*

Not at allSeveral daysMore than half the daysNearly every day
If you checked of any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?*

Not difficult at allSomewhat difficultVery difficultExtremely difficult
Date and Time Submitted*
Please verify that you are human*
Should be Empty:

PHQ-9 GAD-7

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