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Depression Scale (PHQ-9)

Full Name *

Today's Date: *

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Feeling depressed, or hopeless *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Trouble falling or staying asleep, or sleeping too much *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Feeling tired or having little energy *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Poor appetite or overeating *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Feeling bad about yourself or that you are a failure or have let yourself or your family down *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Trouble concentrating on things, such as reading the newspaper or watching television *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

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 Not at all

1 Several days

2 More than half the days

3 Nearly every day

Thoughts that you would be better off dead, or of hurting yourself *

0 Not at all

1 Several days

2 More than half the days

3 Nearly every day

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Address:
26302 La Paz Road, Suite 214

Mission Viejo, CA 92691

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Mission Viejo, CA 92691

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