PHQ-9 and GAD-7 FORMS

PHQ-9 & GAD-7

Please fill out the form below with either your full name or initials and date of birth. ONLY Clinical Staff or the Office Manager of Transformative Growth Counseling will be able to view this form.
Name *

First Name Last Name
Date of Birth *

Day Month Year
Date
Please choose your Therapist from the list below : *

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

Not at all

Several Days

More than half the days

Nearly every day

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 fidgety 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

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

Not at all

Several Days

More than half the days

Nearly every day

1. Feeling nervous, anxious, or on edge

2. Not being able to stop or control worrying

3. Worrying too much about different things

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

PHQ-9 Score (0-4 Minimal) (5-9 Mild) (10-14 Moderate) (15-19 Moderately-Severe) (20+ Severe)
GAD-7 Score (0-5 Minimal) (6-10 Mild) (11-15 Moderate) (16-21 Severe)
Should be Empty:

PHQ-9 and GAD-7 FORMS

PHQ-9 & GAD-7