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  • Client Information

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  • PATIENT HEALTH QUESTIONNAIRE (PHQ-9)

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

  • 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 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
  • If you have checked off 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?

  • Generalized Anxiety Disorder Screener (GAD-7)

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

  • 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 is hard to sit still
  • Becoming easily annoyed or irritated
  • Feeling afraid as if something awful might happen
  • 8. If you checked off 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?

  • WHODAS 2.0

  • This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.

    Think back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. For each question, please choose only one response.

    In the past 30 days, how much difficulty did you have in:

  • Standing for long periods such as 30 minutes?
  • Taking care of your household responsibilities?
  • Learning a new task, for example, learning how to get to a new place?
  • How much of a problem did you have joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
  • How much have you been emotionally affected by your health problems?
  • Concentrating on doing something for ten minutes?
  • Walking a long distance such as a kilometre (or equivalent)?
  • Washing your whole body?
  • Getting dressed?
  • Dealing with people you do not know?
  • Maintaining a friendship?
  • Your day-to-day work?

  • Overall, in the past 30 days, how many days were these difficulties present?

  • In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition?

  • In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition?

  • PTSD CheckList – Civilian Version (PCL-C)

  • Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully, pick the answer that indicates how much you have been bothered by that problem in the last month.

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  • GLOBAL APPRAISAL OF INDIVIDUAL NEEDS (GAIN-SS)

  • Please indicate whether you’ve experienced the following concerns in the: 

    Past Month, 2-12 Months Ago, More than a Year Ago, or Never

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