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850-254-9575
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PATIENT HEALTH QUESTIONNAIRE (PHQ - 9)
PATIENT HEALTH QUESTIONNAIRE (PHQ - 9)
Patient Name
Date of Birth
Phone Number
Email
1. Little interest or pleasure in doing things
Select
0. Not at all
1. Several days
2. More than half the days
3. Nearly every day
2. Feeling down, depressed, or hopeless
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
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
Select
0. Not at all
1. Several days
2. More than half the days
3. Nearly every day
5. Poor appetite or overeating
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
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
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
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
Select
0. Not at all
1. Several days
2. More than half the days
3. Nearly every day
Total Score
Submit
