About this template
This combined PHQ-9 and GAD-7 screening template is designed for healthcare providers and mental health professionals to streamline the patient intake process. By digitizing these standardized clinical assessments, you can collect consistent, actionable data before a patient even walks through the door or logs into a telehealth session. This template helps practitioners quickly identify symptom severity and track patient progress over time.
Using this Google Form template eliminates the need for manual data entry and paper filing. It is structured to provide a clear, professional experience for patients, ensuring that sensitive information is captured accurately. Whether you are conducting initial assessments or routine check-ins, this form provides a reliable, secure way to gather the necessary insights to inform your clinical decision-making process.
Key features
- Standardized PHQ-9 and GAD-7 assessment questions.
- Mobile-friendly design for easy patient access.
- Automated data collection directly into your Google Sheets.
- Customizable fields to add your clinic's branding.
- Reduces administrative burden during intake.
Use cases
- Initial intake for new therapy patients.
- Routine mental health check-ins for ongoing treatment.
- Telehealth pre-appointment screening.
- Clinical research and outcome tracking.
What this form collects
- Full Name (Short answer)Please enter your full legal name.
- Date of Birth (Date)Please provide your date of birth for identification purposes.
- PHQ-9: Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things? (Multiple choice)Select the frequency that best describes your experience.
- PHQ-9: Over the last 2 weeks, how often have you felt down, depressed, or hopeless? (Multiple choice)Select the frequency that best describes your experience.
- GAD-7: Over the last 2 weeks, how often have you felt nervous, anxious, or on edge? (Multiple choice)Select the frequency that best describes your experience.
- GAD-7: Over the last 2 weeks, how often have you been unable to stop or control worrying? (Multiple choice)Select the frequency that best describes your experience.
- Additional Comments (Paragraph)Please share any other information you would like your provider to know.
FAQ
Are these forms compliant with medical privacy standards?
Google Forms is a powerful tool, but you must ensure your specific Google Workspace environment is configured correctly to meet your local healthcare data regulations.
Can I add custom questions to this template?
Yes, once you load this template into your account, you can add, remove, or modify any questions to suit your specific clinical requirements.
How do I share this form with my patients?
You can share the form via a direct link, embed it on your secure patient portal, or send it via email before an appointment.
Can I use this form for telehealth appointments?
Absolutely. It is an ideal solution for remote screenings, allowing patients to complete the questionnaire from the comfort of their own home.
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.