Anxiety Depression Rating Scale
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GAD-7 Patient Health Questionnaire
Today's Date: *
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Patient's Name: *
Patient's Date Of Birth: *
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Over the last two weeks, how often have you been bothered by the following problems? *
0-Not at all
1-Several days
2-More than half the days
3-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
4. Trouble relaxing
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
If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people? *
Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr. Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved.
Reproduced with permission

PHQ-9 Patient Health Questionnaire (Anxiety)
Over the last 2 weeks, how often have you been bothered by any of the following problems? *
0-Not at all
1-Several Days
2-More than half the days
3-Nearly Everyday
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or 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 orhave let yourself or your family down
7. Trouble concentrating on things, such as reading thenewspaper or watching television
8. Moving or speaking so slowly that other people couldhave noticed. Or the opposite being so figety orrestless that you have been moving around a lot morethan usual
9. Thoughts that you would be better off dead, or ofhurting yourself
10. If you selected any problems, how difficult  have these problems  made it for you to do your work, take care of things at home, or get along with other people? *
Copyright@1999 Pfizer, Inc. All rights reserved. Reproduced with PERMISSION. PRIME-MD© is a trademark of Pfizer, Inc. A2663B 10-04-2005
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