GAD / PHQ Assessment GAD 7 & PHQ 9 AssessmentTo be completed every 2 weeks.Client Name *Assessors Name *Date *Hours *-000102030405060708091011121314151617181920212223Minutes *-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859GAD 7 Assessment (Generalised Anxiety Disorder Assessment)In the last two weeks [14 days], how often has the client been bothered by the following items. Score each item [PUT SCORE IN THE BOX] as: 0 = not at all, 1= several days, 2 = more than half of the days, 3 = almost every dayFeeling nervous anxious or on edge? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayNot being able to stop or control worrying? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayWorrying too much about different things? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayTrouble relaxing? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayBeing so restless that it is hard to sit still? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayBecoming easily annoyed or irritable? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayFeeling afraid as if something awful might happen? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayTotal Scores for GAD 7 AssessmentScores from the GAD 7 assessment represent: *Select0-5 mild6-10 moderate11-15 moderately severe anxiety15-21 severe anxietyPHQ 9 Assessment (Patient health questionaire)In the last two weeks [14 days], how often has the client been bothered by the following items. Score each item [PUT SCORE IN THE BOX] as: 0=not at all 1= several days, 2 = more than half of the days, 3=almost every dayLittle interest or pleasure in doing things? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayFeeling down, depressed, or hopeless? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayTrouble falling or staying asleep, or sleeping too much? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayFeeling tired or having little energy? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayPoor appetite or overeating? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayFeeling bad about yourself, or that you are a failure or have let yourself or your family down? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayTrouble concentrating on things, such as reading the newspaper or watching television? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayMoving or speaking so slowly that other people could have noticed? Or the opposite being really fidgety or restless? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayThoughts that you would be better off dead or of hurting yourself in some way? *Select0 - Not at all1 - Several days2 - More than half the days3 - Almost every dayTotal Scores for PHQ 9 AssessmentScores from the PHQ 9 assessment represent: *Select0-4 none5 - 9 Mild10-14 moderate15-19 moderately severe20-27 severeDate of Submission *Time completed *Hours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859SUBMIT ASSESSMENT
