Facebook Twitter Instagram
Book An Appointment
Facebook Twitter Instagram
Book An Appointment
Book An Appointment

PHPHQ-9 and GAD-7

Patient Health Questionnaire and General Anxiety Disorder

(PHQ-9 and GAD-7)

MM slash DD slash YYYY
Patient Name:
MM slash DD slash YYYY

PHQ-9

1. Little interest or pleasure in doing things.
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day(3)
2. Feeling down, depressed, or hopeless.
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.
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day(3)
4. Feeling tired or having little energy.
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day(3)
5. Poor appetite or overeating.
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.
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 the newspaper or watching television.
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.
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.
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day(3)

Add the score for each column

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? (Circle one)
Not difficult at all
Somewhat difficult
Very Difficult
Extremely Difficult
Over the last 2 weeks, how often have you been bothered by any of the following problems? Please circle your answers.

GAD-7

1. Feeling nervous, anxious, or on edge.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
2. Not being able to stop or control worrying.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
3. Worrying too much about different things.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
3. Worrying too much about different things.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
4. Trouble relaxing.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
5. Being so restless that it’s hard to sit still.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
6. Becoming easily annoyed or irritable.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)
7. Feeling afraid as if something awful might happen.
Not at all sure (0)
Several days (1)
Over half the days (2)
Nearly every day (3)

Add the score for each column

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? (Circle one)
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.

An individual counseling session provides a safe, non-judgmental space for self-exploration, understanding, and targeted intervention. Through one-on-one Counseling, we help our clients manage stress, deal with bothersome thoughts and feelings, and handle life’s ups and downs more effectively.

Learn More About Us

Quick Links

Our Services

Contact Us

Facebook Twitter Instagram

Copyright © 2025 · MilShep Counseling Services · Website Design by SpringHive