Name * First Name Last Name Over the last 2 weeks, how often have you been bothered by the following problems? Feeling nervous, anxious or on edge. * Not at all Several days More than half the days Nearly every day Not being able to stop or control worrying. * Not at all Several days More than half the days Nearly every day Worrying too much about different things. * Not at all Several days More than half the days Nearly every day Trouble relaxing. * Not at all Several days More than half the days Nearly every day Being so restless that it is hard to sit still. * Not at all Several days More than half the days Nearly every day Becoming easily annoyed or irritable. * Not at all Several days More than half the days Nearly every day Feeling afraid that something awful might happen. * Not at all Several days More than half the days Nearly every day If you have struggled with any of the above, 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? * Not difficult at all Somewhat difficult Very difficult Extremely difficult Thank you! GAD-7 Anxiety Name * First Name Last Name Over the last 2 weeks, how often have you been bothered by the following problems? Little interest or pleasure in doing things. * Not at all Several days More than half the days Nearly every day Feeling down, depressed or hopeless. * Not at all Several days More than half the days Nearly every day Trouble falling or staying asleep, or sleeping too much. * Not at all Several days More than half the days Nearly every day Poor appetite or overeating. * Not at all Several days More than half the days Nearly every day 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 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 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 more than usual. * Not at all Several days More than half the days Nearly every day Thoughts that you would be better off dead or hurting yourself in some way. Not at all Several days More than half the days Nearly every day Thank you! PHQ-9 Depression