Atlanta Telehealth PHQ9 and GD-7 Forms

Patient Health Questionnaire (PHQ9)
The PHQ-9 is a commonly used screening tool for assessing the severity of depression. It consists of nine questions that are designed to evaluate the frequency and severity of depressive symptoms experienced by individuals.
INSTRUCTIONS

Please read each statement carefully and select the response that best describes how often you have experienced each symptom over the past two weeks.
Name*

First NameLast Name
Date*

MonthDayYear

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

Rows	Not at all-0	Several Days-1	More than half the days-2	Nearly every day-3
1. Little interest or pleasure in doing things
2. Feeling down, depressed or hopeless
3. Trouble falling or staying asleep, sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself-or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or the opposite-being so figety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead, or of hurting yourself

The PHQ-9 has 9 questions, each scored 0–3:
0 = Not at all
1 = Several days
2 = More than half the days
3 = Nearly every day

Total Score Range: 0–27

Severity Levels:
0–4 → Minimal or none
5–9 → Mild depression
10–14 → Moderate depression
15–19 → Moderately severe depression
20–27 → Severe depression
Clinical note: A score of 10 or higher is generally the cutoff for considering clinical intervention.
# of Entry for Not at all*
# of Entry for Several Days*
# of Entry for More than half the days*
# of Entry for Nearly every day*
Total Score for PHQ9
Provide the details here:*

Several Days

More than half the days

Nearly every day

Total: 0/ 27
GAD-7 (Generalized Anxiety Disorder-7)
The GAD-7 (Generalized Anxiety Disorder-7) is a widely used questionnaire for assessing the severity of generalized anxiety disorder symptoms. It consists of seven questions that measure the frequency and severity of anxiety symptoms experienced by individuals. Here is the GAD-7 questionnaire:
INSTRUCTIONS

Please read each statement carefully and select the response that best describes how often you have experienced each symptom over the past two weeks.

Rows	Not at all-0	Several Days-1	More than half the days-2	Nearly every day-3
1. Feeling nervous, anxious, or on edge.
2. Not being able to stop or control worrying.
3. Worrying too much about different things.
4. Trouble relaxing.
5. Being so restless that it is hard to sit still.
6. Becoming easily annoyed or irritable.
7. Feeling afraid, as if something awful might happen.