Patient Health Questionnaire and General Anxiety Disorder
(PHQ-9 and GAD-7)
Date
Patient name
Date of birth
Patient Health Questionnaire (PHQ-9)
Over the
last 2 weeks
how often have you been bothered by any of the following problems? Please select the answer that best applies to you.
Please Select
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.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
2. Feeling down, depressed or hopeless.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
3. Trouble falling or staying asleep, or sleeping too much.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
4. Feeling tired or having little energy.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
5. Poor appetite or overeating.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
7. Trouble concentrating on things, such as reading or watching television.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
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.
Please Select
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
9. Thoughts that you would be better off dead, or of hurting yourself in some way.
If you checked 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
Generalized Anxiety Disorder (GAD-7)
Over the
last 2 weeks
how often have you been bothered by any of the following problems? Please select the answer that best applies to you.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
1. Feeling nervous, anxious or on edge.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
2. Not being able to stop or control worrying.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
3. Worrying too much about different things.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
4. Trouble relaxing.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
5. Being so restless that it’s hard to sit still.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
6. Becoming easily annoyed or irritable.
Please Select
Not at all (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
7. Feeling afraid as if something awful might happen.
If you checked 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
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. UHS Rev 4/2020