Patient Health Questionnaire-9 (PHQ-9)

Please complete the following form.

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First Name*

Last Name*

Phone Number*

Email Address*

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?*

2. Feeling down, depressed, or hopeless?*

3. Trouble falling or staying asleep, or 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 in some way?*

Using the numbers of your answers, please enter your total score.*

In the past year have you felt depressed or sad most days, even if you felt okay sometimes*

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?*

This field is for validation purposes and should be left unchanged.