Los Gatos Doc -- PHQ-9--Questionnaire

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First Name *

Last Name *

Date of Birth *

YYYY

Little interest or pleasure in doing things? *

Feeling down, depressed, or hopeless? *

Trouble falling or staying asleep, or sleeping too much? *

Feeling tired or having little energy? *

Poor appetite or overeating? *

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

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

Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual? *

Thoughts that you would be better off dead, or thoughts of hurting yourself in some way? *

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