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Patient Health Questionnaire PHQ - 9
*
Indicates required field
Name
*
First
Last
Try to answer these questions with your first response:
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
Choose one
*
not at all
several days
more than half the days
nearly every day
2. Feeling down, depressed, or hopeless
Choose one
*
not at all
several days
more than half the days
nearly every day
3. Trouble falling/staying asleep and/or sleeping too much
Choose one
*
not at all
several days
more than half the days
nearly every day
4. Feeling tired or having little energy
Choose one
*
not at all
several days
more than half the days
nearly every day
5. Poor appetite or overeating
Choose one
*
not at all
several days
more than half the days
nearly every day
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
Choose one
*
not at all
several days
more than half the days
nearly every day
7. Trouble concentrating on things, such as reading the newspaper watching TV.
Choose one
*
not at all
several days
more than half the days
nearly every day
8. Moving or speaking so slowly that other people have noticed. Or the opposite: being so fidgety or restless that you have been moving around a lot more than usual.
Choose one
*
not at all
several days
more than half the days
nearly every day
9. Thoughts that you would be better off dead or of hurting yourself in some way.
Choose one
*
not at all
several days
more than half the days
nearly every day
If you checked off any problem on this questionnaire so far, how difficult have the problems made it for you to do your work, take of things at home, or get along with other people?
Choose one
*
not at all
several days
more than half the days
nearly every day
Submit
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