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neurocare Centers of America
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neurocare Centers of America
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New Patient Form

Patient Health Questionnaire (PHQ-9)

"*" indicates required fields

Name*

Patient Health Questionnaire (PHQ-9)

Over the last 2 weeks, how often have you been bothered by any of the following problems? (Please mark corresponding responses)
Feeling down, depressed, or hopeless*
Little Interest or pleasure in doing things*
Feeling tired or having little energy*
Trouble falling or staying asleep, or sleeping too much*
Feeling bad about yourself — or that you are a failure or have let yourself or your family down*
Poor Appetite or overeating*
Thoughts that you would be better off dead, or of hurting yourself*
Trouble concentrating on things, such as reading the newspaper or watching television*
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*
Important Safety Notice*