About this template
This comprehensive questionnaire template combines the standard PHQ-9 (Patient Health Questionnaire) for depression screening and the GAD-7 (Generalized Anxiety Disorder) scale into a single, streamlined digital assessment. Designed for clinicians, therapists, and healthcare providers, it helps gather crucial mental health and symptom history directly from patients before appointments or telehealth sessions.
Collecting standardized symptom data online allows practitioners to review scores efficiently and prepare for consultations with complete clinical context. Patients can complete the form privately from any smartphone, tablet, or computer, reducing wait-room paperwork and minimizing data entry errors for clinic staff. Doc2Form makes it simple to deploy this screening tool as part of your standard intake process while maintaining a seamless experience for respondents.
Key features
- Combines standardized PHQ-9 and GAD-7 screening matrices in one flow
- Accessible on mobile and desktop devices for easy remote completion
- Streamlines pre-visit intake and mental health status evaluations
- Customizable questions to fit specific clinical practice requirements
- Instantly capture responses in a structured spreadsheet format
Use cases
- Initial intake assessments for new mental health counseling clients
- Routine check-ins and progress monitoring during ongoing therapy
- Pre-appointment screening for telehealth or virtual clinic visits
- General wellness evaluations in primary care practices
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Enter your date of birth.
- Today's Date (Date)Select today's date.
- 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 applies to you.
- PHQ-9: Feeling down, depressed, or hopeless (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- PHQ-9: Trouble falling or staying asleep, or sleeping too much (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- PHQ-9: Feeling tired or having little energy (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- PHQ-9: Poor appetite or overeating (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- PHQ-9: 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 experienced this?
- PHQ-9: Trouble concentrating on things, such as reading the newspaper or watching television (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- PHQ-9: 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 (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- PHQ-9: 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 experienced this?
- GAD-7: Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge? (Multiple choice)Select the frequency that best applies to you.
- GAD-7: Not being able to stop or control worrying (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- GAD-7: Worrying too much about different things (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- GAD-7: Trouble relaxing (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- GAD-7: Being so restless that it is hard to sit still (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- GAD-7: Becoming easily annoyed or irritable (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- GAD-7: Feeling afraid as if something awful might happen (Multiple choice)Over the last 2 weeks, how often have you experienced this?
- Additional Comments or Concerns (Paragraph)Please share anything else you would like your healthcare provider to know.
FAQ
What screenings are included in this template?
This template includes both the PHQ-9 for assessing depression symptoms and the GAD-7 for evaluating generalized anxiety disorder severity.
Can patients complete this form on their mobile phones?
Yes, the form is fully responsive and can be easily filled out on any smartphone, tablet, or computer.
How do I customize the questions for my clinic?
Once your template is generated in Google Forms, you can freely edit, add, or remove questions, adjust settings, and brand the form with your practice logo.
Is this form suitable for telehealth appointments?
Absolutely. It is ideal for remote data collection, allowing patients to submit their mental health assessments securely before a virtual consultation.
Get this form in your Google Drive
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