GAD / PHQ Assessment

GAD 7 & PHQ 9 Assessment

Client Name *

Assessors Name *

Date *

Hours *

Minutes *

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 is hard to sit still? *

Becoming easily annoyed or irritable? *

Feeling afraid as if something awful might happen? *

Total Scores for GAD 7 Assessment

Scores from the GAD 7 assessment represent: *

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 really fidgety or restless? *

Thoughts that you would be better off dead or of hurting yourself in some way? *

Total Scores for PHQ 9 Assessment

Scores from the PHQ 9 assessment represent: *

Email Address *If you would like a copy of this for future sessions please enter your work email here