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Dr Liliya Korallo
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Generalised Anxiety Disorder Questionnaire (GAD7)
Patient Name
Date of Birth
Day
Month
Month
Year
Date of Session
Over the
last 2 weeks
, how often have you been bothered by any of the following problems?
1. Feeling nervous, anxious or on edge
Not at all
Several days
More than half the days
Nearly every day
2. Not being able to stop or control worrying
Not at all
Several days
More than half the days
Nearly every day
3. Worrying too much about different things
Not at all
Several days
More than half the days
Nearly every day
4. Trouble relaxing
Not at all
Several days
More than half the days
Nearly every day
5. Being so restless that it is hard to sit still
Not at all
Several days
More than half the days
Nearly every day
6. Becoming easily annoyed or irritable
Not at all
Several days
More than half the days
Nearly every day
7. Feeling afraid as if something awful might happen
Not at all
Several days
More than half the days
Nearly every day
Submit
Book a 15 min Consultation to Discuss Results
Patient Health Questionnaire (PHQ9)
Patient Name
Date of Birth
Day
Month
Month
Year
Date of Session
Over the
last 2 weeks
, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things
Not at all
Several days
More than half the days
Nearly every day
2. Feeling down, depressed, or hopeless
Not at all
Several days
More than half the days
Nearly every day
3. Trouble falling or staying asleep, or sleeping too much
Not at all
Several days
More than half the days
Nearly every day
4. Feeling tired or having little energy
Not at all
Several days
More than half the days
Nearly every day
5. Poor appetite or overeating
Not at all
Several days
More than half the days
Nearly every day
6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down
Not at all
Several days
More than half the days
Nearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television
Not at all
Several days
More than half the days
Nearly every day
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
Several days
More than half the days
Nearly every day
9. Thoughts that you would be better off dead or of hurting yourself in some way
Not at all
Several days
More than half the days
Nearly every day
Submit
Book a Free 15 min Consultation To Discuss Results
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