PHQ-9 Depression Assessment Form

First Name

Middle Name

Last Name

1. Little interest or pleasure in dong things

0

1

2

3

2. Feeling down, depressed, or hopeless

0

1

2

3

3. Trouble falling or staying asleep, or sleeping too much

0

1

2

3

4. Feeling tired or having little energy

0

1

2

3

5. Poor appetite or overeating

0

1

2

3

6. Feel bad about yourself - or that you are a failure or have let yourself or your family down

0

1

2

3

7. Trouble concentrating on things, such as reading the newspaper or watching televison

0

1

2

3

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

0

1

2

3

9. Thoughts that you would be better off dead, or hurting yourself in some way

0

1

2

3

Column Totals

0

1

2

3

Total