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Patient Health Questionnaire – PHQ9UHSDEV2021-04-07T16:06:20-04:00

Patient Health Questionnaire – PHQ9

Patient Health Questionnaire (PHQ-9)

Patient Name*
First Last
Date Completed*
MM slash DD slash YYYY
Little interest or pleasure in doing things*
- Not at all
- Several day
- More than half the days
- Nearly every day
Feeling down, depressed or hopeless*
- Not at all
- Several day
- More than half the days
- Nearly every day
Trouble falling or staying asleep, or sleeping too much*
- Not at all
- Several day
- More than half the days
- Nearly every day
Feeling tired or having little energy*
- Not at all
- Several day
- More than half the days
- Nearly every day
Poor appetite or overeating*
- Not at all
- Several day
- More than half the days
- Nearly every day
Feeling bad about yourself - or that you are a failure or have let yourself or your family down*
- Not at all
- Several day
- More than half the days
- Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television*
- Not at all
- Several day
- More than half the days
- Nearly every day
Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have not been moving around a lot more than usual*
- Not at all
- Several day
- More than half the days
- Nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way*
- Not at all
- Several day
- More than half the days
- Nearly every day
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*
- Not at all difficult
- Somewhat difficult
- Very difficult
- Extremely difficult
Program Type*
- PHP-5 day
- Day IOP-3 day
- Evening IOP
- Adolescent IOP

We’re Always Here to Help

Licensed mental health professionals are available 24 hours a day, 7 days a week to assist you or your loved one. To schedule a no-cost assessment or for more information, please call 407-370-0111.

Patient Health Questionnaire – PHQ9

Physicians are on the medical staff of Central Florida Behavioral Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Central Florida Behavioral Hospital. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved. There are risks associated with any treatment procedure and individual results may vary. Please consult the dedicated professionals within the ECT program at Central Florida Behavioral Hospital to assess if you are a candidate for ECT treatment. Our medical staff will also consult with you on the risks and benefits of ECT treatment if you are a suitable candidate.

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