PHQ & GAD-7 - TMS
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Patient Name
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First Name
Last Name
Patient DOB
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PHQ-9
Over the last 2 weeks, how often have you been bothered by any of the following problems?
*
Rows
Not at
all
Several
days
More than half
the days
Nearly
every day
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.
PHQ-9 Score
*
If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
GAD-7
Over the last 2 weeks, how often have you been bothered by any of the following problems?
*
Rows
Not at all
sure
Several
days
Over half
the days
Nearly
every day
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 if something awful might happen.
GAD-7 Score
*
If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
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