• PHQ-9 and GAD-7

    Answer based on the last 2 weeks, and complete the required patient details before starting.
  • If you are in crisis, do not use this formThis questionnaire is not monitored continuously and may not be read for several days. If you are thinking about harming yourself, call or text 988 (Suicide and Crisis Lifeline), call 911, or go to your nearest emergency room.

  • Patient Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Today’s Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • 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 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*
  • If you answered anything other than 'Not at all' to the question above, please call the office at 202-775-0620 today. If you are in immediate danger, call or text 988, or call 911.
  • 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?*

  • GAD-7

  • Over the last 2 weeks, how often have you been bothered by any of 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's hard to sit still*
  • Becoming easily annoyed or irritable*
  • Feeling afraid as if something awful might happen*
  • 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?*
  • Should be Empty: