Patient Health Questionnaire and General Anxiety Disorder (PHQ-9 and GAD-7)


Date  Patient Name  Date of Birth  

Over the last 2 weeks how often have you been bothered by any of the following problems?
PHQ-9

1. Little interest or pleasure in doing things


2. Feeling down, depressed, or hopeless

3. Trouble falling or staying asleep, or 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 fidgety or restless that you have been moving around a lot more than usual.

9. Thoughts that you would be better off dead, or hurting yourself in some way.

Total for - Not at all  
Total for  - Several days  
Total for - Over half the days  
Total for - Nearly every day  
Total Score (add your column 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?


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

GAD-7

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's hard to sit still.

6. Becoming easily annoyed or irritable.

7. Feeling afraid as if something awful might happen.

Total for - Not at all sure  
Total for  - Several days  
Total for - More than half the days  
Total for - Nearly every day  
Total Score (add your column 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?


Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.
No permission required to reproduce, translate, display or distribute, 1999.

Leave this empty:

Signature arrow


Signature Certificate
Document name: Patient Health Questionnaire and General Anxiety Disorder (PHQ-9 and GAD-7)
lock iconUnique Document ID: 590a5ff75cbd884109263a0e7fcf896d150086d9
Timestamp Audit
August 20, 2021 11:22 am PDTPatient Health Questionnaire and General Anxiety Disorder (PHQ-9 and GAD-7) Uploaded by Adam Falk - adam.falk@options.org IP 50.240.25.195
August 31, 2021 9:27 am PDTLane MAA - LMPsupport@options.org added by Adam Falk - adam.falk@options.org as a CC'd Recipient Ip: 50.240.25.195