Patient Health Questionnaire (PHQ9) Name* First Last Date of birth* Over the last two weeks, how often have you been bothered by any of the following problems?1. Little interest or pleasure in doing things*Not at allSeveral daysMore than half the daysNearly every day2. Feeling down, depressed, or hopeless*Not at allSeveral daysMore than half the daysNearly every day3. Trouble falling or staying asleep, or sleeping too much*Not at allSeveral daysMore than half the daysNearly every day4. Feeling tired or having little energy*Not at allSeveral daysMore than half the daysNearly every day5. Poor appetite or overeating*Not at allSeveral daysMore than half the daysNearly every day6. Feeling bad about yourself, or that you are a failure or have let yourself or your family down*Not at allSeveral daysMore than half the daysNearly every day7. Trouble concentrating on things, such as reading newspaper or watching TV*Not at allSeveral daysMore than half the daysNearly every day8. Moving or speaking so slowly that othe people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual*Not at allSeveral daysMore than half the daysNearly every day9. Thoughts that you would be better off dead, or of hurting yourself*Not at allSeveral daysMore than half the daysNearly every day10. If you have 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?*Not difficult at allSomewhat difficultVery difficultExtremely difficult