Geriatric Depression Scale

Date:

Patient Name:

	Yes	No
1. Are you basically satisfied with your life?	0	1
2. Have you dropped many of your activities and interests?	1	0
3. Do you feel that your life is empty?	1	0
4. Do you often get bored?	1	0
5. Are you are you in good spirits most of the time?	0	1
6. Are you afraid something bad is going to happen to you?	1	0
7. Do you feel happy most of the time?	0	1
8. Do you often feel helpless?	1	0
9. Do you prefer to stay at home, rather than going out and doing new things?	1	0
10. Do you feel you have more problems with memory than most?	1	0
11. Do you think it is wonderful to be alive?	0	1
12. Do you feel pretty worthless the way you are now?	1	0
13. Do you feel full of energy?	0	1
14. Do you feel your situation is hopeless?	1	0
15. Do you think that most people are better off than you are?	1	0
Total (over 5 indicates depression)

Subject:

Need a custom eForm created? Order yours here

Learn how to easily email this eForm securely