PHQ-9 Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPATIENT HEALTH QUESTIONNAIRE (PQ9): Please Slide The Scales And Answer The Questions Using The Scoring SystemOver The Last Two Weeks, How Often Have You Been Bothered By Any Of The Following Problems? 0 = Not At All, 1 = Several Days, 2 = More Than Half The Days, 3 = Nearly Every DayI have Very Little Interest or Pleasure In Doing Things Selected Value: 0 Feeling Down, Depressed, And/Or Hopeless Selected Value: 0 Trouble Falling Asleep, Staying Asleep, Or Sleeping Too Much Selected Value: 0 Thoughts Much Provided Overeating Selected Value: 0 Poor Appetite Selected Value: 0 Feeling Bad About Yourself - Or That You Are A Failure, Have Let Yourself/Your Family Down Selected Value: 0 Trouble Concentrating On Things, Such As Reading or Watching TV Selected Value: 0 Feeling Fidgety Or Restless Selected Value: 0 Moving Or Speaking Slowly Selected Value: 0 Harmful Thoughts (Suicidal, Self-Depricating) Selected Value: 0 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? *--- Select Choice ---Not Difficult At AllSomewhat DifficultVery DifficultExtremely DifficultIf You Checked YES To More Than One Of The Above, Have Several Of These Ever Happened During The Same Period Of Time? *YesNoI Don't Really Know By Submitting This Form I Acknowledge the Information Provided is Accurate and Truthful, To The Best Of My Knowledge *YesFOR OFFICE USE ONLY: PATIENT PQ9 SCORESubmit
