Patient Health Questionnaire; PHQ-9

1. Little interest or pleasure in doing things
   Not at all Several days More than half the days Nearly every day
2. Feeling down, depressed, or hopeless
   Not at all Several days More than half the days Nearly every day
3. Trouble falling/staying asleep, sleeping too much
   Not at all Several days More than half the days Nearly every day
4. Feeling tired or having little energy
   Not at all Several days More than half the days Nearly every day
5. Poor appetite or overeating
   Not at all Several days More than half the days Nearly every day
6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down
   Not at all Several days More than half the days Nearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television
   Not at all Several days More than half the days Nearly every day
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.
   Not at all Several days More than half the days Nearly every day
9. Thoughts that you would be better off dead or of hurting yourself in some way.
   Not at all Several days More than half the days Nearly every day
10. If you have been bothered by any of the 9 questions above, please answer the following - How difficult have these problems made it for you to do your work, take care of things , or get along with other people?
    Not difficult at all Somewhat difficult Very difficult Extremely difficult

If you are completing this assessment as part of our pre-assessment process, please include your initials so that we can identify your results. If you wish to receive a copy of your results by email, please also include your email address in the fields provided below:

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