Patient Health Questionnaire - 9

Over the last 2 weeks, how often have you be bothered

By any of the following problems

Check only box for each question

Not at all

Several days

More than

half the days

Nearly every

day

______________________________________________________________________________________________

1.  Little interest or pleasure doing things

______________________________________________________________________________________________

2.  Felling down, depressed, or hopeless

______________________________________________________________________________________________

3.  Trouble falling or staying asleep, or trouble sleeping too much

______________________________________________________________________________________________

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

______________________________________________________________________________________________

7.  Trouble concentrating on things, such as reading the

     newspaper or watching television

______________________________________________________________________________________________

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 normal 

______________________________________________________________________________________________

9.   Thoughts that you would be better off dead or of hurting

      yourself in some way

For office coding ________ + __________ + _________ + __________

= Total Score:  __________

______________________________________________________________________________________________

If you checked any of the 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 all

Somewhat difficult 

Very difficult 

Extremely difficult 

Call us:

801-683-1062

Locations: 

415 South Medical Drive, Suite D101, Bountiful, UT 84010 

327 West Gordon Avenue, Suite 1, Layton, UT 84041

370 East South Temple, Suite 175, Salt Lake City, UT 84111

5974 S Fashion Pointe Dr., Suite 140, South Ogden, UT 84403

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