Patient Health Questionnaire (PHQ-9)
Over the last 2 weeks, how often have you been
bothered by any of the following problems?
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Patient Name *
Patient Phone Number *
Patient Email Address *
Do you see a provider at our clinic? *
Little interest or pleasure in doing things *
Feeling down, depressed, or hopeless *
Trouble falling or staying asleep, or sleeping too much *
Feeling tired or having little energy *
Poor appetite or overeating *
Feeling bad about yourself or that you are a failure or have let yourself or your family down *
Trouble concentrating on things, such as reading the newspaper or watching television *
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 *
Thoughts that you would be better off dead, or of hurting yourself *
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? *
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