Hybrid Medical Solution
Patient Health Questioninaire (PHQ-9)
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things:
Not at all (0)
Several Days (1)
More Than half the days (2)
Nearly every day (3)
Feeling down, depressed, or hopeless
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Trouble falling or staying asleep, or sleeping to much
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Feeling tired or having little engery
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Poor appetite or overeating
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Feeling bad about yourself - or that you are a failure or have let yourself or your family down
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Trouble concerrntrating on things, such as reading the newspaper or watching television
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Moving or speaking so slowly that other people could have noticed. Or the opposite - being so figety or restless that you have been moving around a lot more than usual
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Thoughts that you woul be better off dead or of hurting yourself
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Healthcare professional: For interpretation of Total, please refer to accompanying scoring card. (Total of above)
If you checked off any problems, how difficult have these problems made it for you to do your wor, take care of things at home, or get along with other people?
Not difficiult at all
Somewhat difficult
Very difficult
Extremely difficult
Submit
Should be Empty: