Patient Health Questionnaire (PHQ-9)
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Today's Date
*
Over the last 2 weeks, how often have you been bothered by and of the following problems?
*
Rows
Not at all
Several Days
More than half the days
Nearly every day
1. Little interest or pleasure in doing things
2. Feeling down, depressed or hopeless
3. Trouble falling or staying asleep, sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself-or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. 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
9. Thoughts that you would be better off dead, or of hurting yourself
Your PHQ-9 Score is:
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 Difficult at all
Somewhat Difficult
Very Difficult
Extremely Difficult
Would you be interested in learning about a safe, effective, non-drug treatment for depression?
YES
NO
Submit
Should be Empty: