SELF-RATED DEPRESSION SCALE | PHQ-9 SCREENER

Name *
Name
Date
Date
Please indicate how often you have been bothered by these problems over the last two weeks.
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 in some way? *
If you checked off ANY problem, 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? *

PATIENT PORTAL  |  MEDICAL HISTORY FORM | SELF-RATED DEPRESSION SCALE | SELF-RATED ANXIETY SCALE  | CANCELLATION POLICY  |  PRIVACY POLICY  |  TREATMENT DOWNPAYMENT  |  TREATMENT CONSENT FORM  | ACKNOWLEDGEMENT OF ONGOING CARE FORM

*Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.