Patient Health Questionnaire - 9 (PHQ-9)Please complete this form and we will contact you for interpretation and any needed next steps. Name * First Name Last Name Date of birth * Email * Over the last 2 weeks how often have you been bothered by the following problems? Little interest or pleasure in doing things * Not at all Several days More than half the days Nearly every day Feeling down, depressed or hopeless * Not at all Several days More than half the days Nearly every day Trouble falling asleep, staying asleep, or sleeping too much * Not at all Several days More than half the days Nearly every day Feeling tired or having little energy * Not at all Several days More than half the days Nearly every day Poor appetite or overeating * Not at all Several days More than half the days Nearly every day Feeling bad about yourself - or that you are a failure or have let yourself or your family down * Not at all Several days More than half the days Nearly every day Trouble concentrating on things, such as reading the newspaper or watching television * Not at all Several days More than half the days Nearly every day 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 all Several days More than half the days Nearly every day Thoughts that you would be better off dead or of hurting yourself in some way * Not at all Several days More than half the days Nearly every day Thank you!
