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Patient Health Questionnaire-9 (PHQ-9) Scale
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Name:
Gender:
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Age:
Marital Status:
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Email ID
Contact No
Date
MM
/
DD
/
YYYY
1. Little interest or pleasure in doing things.
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  2. Feeling down, depressed, or hopeless  
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  3. Trouble falling or staying asleep, or sleeping too much.  
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  4. Feeling tired or having little energy.   
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  5. Poor appetite or overeating.  
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  6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down.   
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  7. Trouble concentrating on things, such as reading the newspaper or watching television.  
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  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.  
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  9. Thoughts that you would be better off dead or of hurting yourself in some way.  
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10. Other: _________. 
(Mention your problem, which your facing any difficulties).
PEARLSS 4 Development Private Limited (OPC)/ AMITA Care 
Counselling and Psychotherapy Services
License No: 18/2023/SMHA, T.S. Dated 21.09.2023
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