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Programs & Services
Inpatient
Affective Disorder
Dual Diagnosis
Psychiatric Intensive Care
Outpatient
Intensive Outpatient Program
Partial Hospitalization Program
Virtual Adolescent IOP
Child Programs
Adolescent Programs
General Adult
Mature Adult
Electroconvulsive Therapy (ECT)
About Us
Welcome from our CEO
Leadership Team
Medical Staff
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Make a Referral
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Patient Health Questionnaire – GAD7
uhs@CFBH
2024-06-10T14:40:29+00:00
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Patient Health Questionnaire – GAD7
Patient Health Questionnaire – GAD7
Patient Name
*
First
Last
Date Completed
*
MM slash DD slash YYYY
Feeling nervous, anxious or on edge
*
Not at all
Several day
More than half the days
Nearly every day
Not being able to stop or control worrying
*
Not at all
Several day
More than half the days
Nearly every day
Worrying too much about different things
*
Not at all
Several day
More than half the days
Nearly every day
Trouble relaxing
*
Not at all
Several day
More than half the days
Nearly every day
Being so restless that it is hard to sit still
*
Not at all
Several day
More than half the days
Nearly every day
Becoming easily annoyed or irritable
*
Not at all
Several day
More than half the days
Nearly every day
Feeling afraid as if something awful might happen
*
Not at all
Several day
More than half the days
Nearly every day
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
*
Not at all difficult
Somewhat difficult
Very difficult
Extremely difficult
Program Type
*
PHP-5 day
Day IOP-3 day
Evening IOP
Adolescent IOP
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