Depression Assessment (PHQ-9)

A copy of your results will be sent to you and to Help Specialist. Should your score indicate you are depressed, we may contact you to discuss available treatment options, including but not limited to ketamine infusion therapy.
Name
Date
YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Email
example@example.com
Phone Number
Area CodePhone Number
The following questionnaire consists of 9 statements. Please read each group of statements carefully, and then pick out the one statement in each group that best describes the way you have been feeling during the past two weeks, including today. If several statements in the group seem to apply equally well, select the highest number for that group.

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

Rows	Not At All	Several Days	More than half the days	Nearly Everyday
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much

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

Rows	Not At All	Several Days	More than half the days	Nearly Everyday
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down

Over the last 2 weeks, how often have you been bothered by any of the following problems?
Rows Not At All Several Days More than half the days Nearly Everyday
7. Trouble concentrating on things, such as reading the newspaper or watching television

Rows	Not At All	Several Days	More than half the days	Nearly Everyday
7. Trouble concentrating on things, such as reading the newspaper or watching television

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

Rows	Not At All	Several Days	More than half the days	Nearly Everyday
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.

Over the last 2 weeks, how often have you been bothered by any of the following problems?
Rows Not At All Several Days More than half the days Nearly Everyday
9. Thoughts that you would be better off dead or of hurting yourself in some way
If you checked off any problems, 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?
Rows Not At All Several Days More than half the days Nearly Everyday
Check One
Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.
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