PHQ-9

PHQ-9
Name*

First NameLast Name
DOB*

MonthDayYear
Date
Therapist you’re scheduled with*

First NameLast Name
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things

Not at allSeveral DaysMore than half the daysNearly every day
2. Feeling down, depressed, or hopeless

Not at allSeveral DaysMore than half the daysNearly every day
3. Trouble falling or staying asleep, or sleeping too much

Not at allSeveral DaysMore than half the daysNearly every day
4. Feeling tired or having little energy

Not at allSeveral DaysMore than half the daysNearly every day
5. Poor appetite or overeating

Not at allSeveral DaysMore than half the daysNearly every day
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down

Not at allSeveral DaysMore than half the daysNearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television

Not at allSeveral DaysMore than half the daysNearly 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

Not at allSeveral DaysMore than half the daysNearly every day
9. Thoughts that you would be better off dead or of hurting yourself in some way

Not at allSeveral DaysMore than half the daysNearly 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 difficult at allSomewhat difficultVery difficultExtremely difficult
Copyright © Pfizer Inc. All rights reserved. Developed by Drs. Robert L. Spitzer, Janet B Williams, and Kurt Kroenke.
(For office coding: Total Score)
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