Patient Full name
*
Patient date of birth
*
Enter MM/DD/YYYY.
PHQ-9 total (questions 1–9; 0–27)
Calculated from the nine answers. Your clinician will review the answers, score, and daily functioning; this score is not a diagnosis.
PHQ-9
Over the last 2 weeks, how often have you been bothered by any of the following problems? Select one answer for each question.This questionnaire helps your clinician understand your symptoms; it is not a diagnosis. This form is not monitored continuously. If you need immediate emotional support, call or text 988. Call 911 for immediate danger or a medical emergency.
1. Little interest or pleasure in doing things
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
2. Feeling down, depressed, or hopeless
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
3. Trouble falling or staying asleep, or sleeping too much
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
4. Feeling tired or having little energy
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
5. Poor appetite or overeating
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
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
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
9. Thoughts that you would be better off dead or of hurting yourself in some way
*
Please Select
0 Not at all
1 Several days
2 More than half the days
3 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?
Please Select
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
This question is not included in the PHQ-9 total score.
Your goals and person completing this questionnaire
Goal(s)
Name of person completing this questionnaire (if different from patient)
Signature (optional)
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Submit
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