Patient Health Questionnaire (PHQ-9)

First Name*

Last Name*

	Several days	More than half the days	Nearly every day	Not at all
Over the last 2 weeks, how often have you felt little interest or pleasure in doing things Please answer this question.
Over the last 2 weeks, how often have you felt down, depressed, or hopeless Please answer this question.
Over the last 2 weeks, how often have you felt trouble falling or staying asleep, or sleeping too much Please answer this question.
Over the last 2 weeks, how often have you felt tired or having little energy Please answer this question.
Over the last 2 weeks, how often have you experienced poor appetite or overeating Please answer this question.
Over the last 2 weeks, how often have you felt bad about yourself – or that you are a failure or have let yourself or your family down Please answer this question.
Over the last 2 weeks, how often have you felt trouble concentrating on things, such as reading the newspaper or watching television Please answer this question.
Over the last 2 weeks, how often have you been 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 Please answer this question.
Over the last 2 weeks, how often have you had thoughts that you would be better off dead or of hurting yourself in some way Please answer this question.