Patient Health Questionnaire-9
The following assessment is used measure your symptoms over the course of several weeks. You are encouraged to complete this form every two months and talk about any concerns at your next session. 

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Email *
Client Name *
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Feeling down, depressed, or hopeless
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Trouble falling or staying asleep, or sleeping too much
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Feeling tired or having little energy
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Poor appetite or overeating
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Trouble concentrating on things, such as reading the newspaper or watching television
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
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
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
Thoughts that you would be better off dead or of hurting yourself in some way
Your Answer
Not at all
Several days
More than half the days
Nearly every day
Clear selection
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?
Your Answer
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Clear selection
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