PHQ – East Florida

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
Patient Name*
First Last
DOB
Date Format: MM slash DD slash YYYY
Date
Date Format: MM slash DD slash YYYY
Over the last 2 weeks, how often have you been bothered by any of the following problems? Not At All Several days More than half the days Nearly every day
Little interest or pleasure in doing things
- 0
- 1
- 2
- 3
Feeling down, depressed, or hopeless
- 0
- 1
- 2
- 3
Trouble falling/staying asleep, sleeping too much
- 0
- 1
- 2
- 3
Poor appetite or overeating
- 0
- 1
- 2
- 3
Feeling bad about yourself or that you are a failure or have let yourself or your family down
- 0
- 1
- 2
- 3
Trouble concentrating on things, such as reading the newspaper or watching television.
- 0
- 1
- 2
- 3
Thoughts that you would be better off dead or of hurting yourself in some way.
- 0
- 1
- 2
- 3
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..
- 0
- 1
- 2
- 3
(Healthcare professional: For interpretation of TOTAL, please refer to accompanying scoring card)
Total Points
Select any one option

	Select Options
Select any one option	Not difficult at all	Somewhat difficult	Very difficult	Extremely difficult
If you checked off any problem on this questionnaire so far, 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?	Not difficult at all	Somewhat difficult	Very difficult	Extremely difficult

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