About this template
This Depression Assessment Google Form template provides a structured, validated approach to screening and tracking depressive symptoms over time. Designed for mental health professionals, primary care providers, and counselors, this questionnaire collects critical patient feedback regarding mood, sleep patterns, energy levels, and overall well-being. Using a standardized symptom-scoring framework, clinicians can quickly evaluate symptom severity during intake sessions or routine check-ins.
Built on Doc2Form, this template allows clinics and wellness practitioners to instantly deploy a secure questionnaire via Google Forms. By streamlining the initial screening process, providers can better focus on patient care and treatment planning while maintaining an organized, digital record of client responses.
Key features
- Standardized symptom screening questions for reliable evaluation.
- Built using Google Forms for seamless patient access and mobile responsiveness.
- Collects essential contact details alongside clinical indicators.
- Easy to customize for individual clinical practices or research studies.
Use cases
Initial patient intake at mental health clinics and counseling practi…
Initial patient intake at mental health clinics and counseling practices.
Routine progress evaluations during ongoing psychotherapy treatment.
Telehealth remote pre-screening before scheduled virtual appointments.
What this form collects
- Assessment Date (Date)Enter today's date.
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)Provide the best email address for follow-up communication.
- Phone Number (Short answer)Enter your primary contact number.
- Little interest or pleasure in doing things (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Feeling down, depressed, or hopeless (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Trouble falling or staying asleep, or sleeping too much (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Feeling tired or having little energy (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Poor appetite or overeating (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Feeling bad about yourself — or that you are a failure or have let yourself or your family down (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Trouble concentrating on things, such as reading the newspaper or watching television (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Moving or speaking so slowly that other people could have noticed, or being so fidgety or restless (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- Thoughts that you would be better off dead, or of hurting yourself in some way (Multiple choice)Over the last 2 weeks, how often have you been bothered by this?
- If you checked off 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? (Dropdown)Select the option that best describes your overall functional difficulty.
FAQ
How do I share this depression assessment with patients?
Once generated in Google Forms, you can share the assessment via a direct link, email invitation, or by embedding it securely on your practice website.
Can I customize the questions on this form?
Yes. Since the template lives directly in your Google Drive, you can easily add, remove, or modify questions to fit your specific clinical requirements.
Is patient data secure when using Google Forms?
Google Forms uses robust encryption in transit and at rest. Ensure your Google Workspace account meets your organization's required privacy and security standards before collecting sensitive health data.
How can Doc2Form help me create more templates?
Doc2Form lets you instantly convert existing documents, PDFs, or text prompts into ready-to-use Google Forms in just seconds.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.