PHQ-9 PHQ-9 PHQ-9 Form (Select Appropriate Clinic) For which clinic is this form? logo acf-forms activecampaign authorize aweber bootstrap campaignmonitor constant_contact getresponse googlesheets highrise hubspot mailchimp mailpoet paypal icon polylang salesforce salesforcealt stripe stripealt twilio woocommerce Zapier required delete move drag clear noclear duplicate copy clone tooltip tooltip_solid forbid checkmark image checkmark circle checkmark square check check1 plus plus1 plus2 plus3 plus4 minus minus1 minus2 minus3 minus4 cancel cancel1 close report_problem_solid report_problem arrowup arrowup1 arrowup2 arrowup3 arrowup4 arrowup5 arrowup5_solid arrowup7 arrowup6 arrowup8 arrowdown arrowdown1 arrowdown2 arrowdown3 arrowdown4 arrowdown5 arrowdown5_solid arrowdown7 arrowdown6 arrow_left arrow_right filter download upload2 download2 hard_drive pencil_solid pencil signature register account_circle_solid account_circle address_card paragraph checkbox_unchecked checkbox checkbox_solid dropdown caret_square_down radio_unchecked scrubber location_solid location toggle_on toggle_off shield_check shield_check_solid clock clock_solid email_solid mail_bulk code tag tag_solid price_tags search sitemap file file_text_solid file_text option option_solid more_horiz more_vert more_horiz_solid more_vert_solid calculator key key Filled Key Icon keyboard eye eye_solid eye_slash_solid page_break view_day attach_file printer header h1 repeat repeater save sliders code_commit star star_full star_half linear_scale pie_chart stats_bars sms feed align_right align_left button browser cloud_upload_solid shuffle swap pallet fingerprint ghost heart_solid heart history import export label_solid label lock_open lock alt_lock dollar_sign percent notification external_link pageview_solid pageview settings stamp support text white_label building icontact sendinblue sendy wordpress credit_card credit_card_alt cc_amex cc_discover cc_mastercard cc_visa cc_paypal icon cc_stripe price product total quantity directory Preview Storybook Pediatrics G. F. Still ADHD Clinic Email to send my copy Confirm Email to send my copy Email and email verification Date * (MM/DD/YYYY) Child's Name * DOB * (MM/DD/YYYY) Over the last 2 weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things Not at all Several Days More than half the days Nearly every day 2. Feeling down, depressed, or hopeless Not at all Several Days More than half the days Nearly every day 3. Trouble falling or staying asleep, or sleeping too much Not at all Several Days More than half the days Nearly every day 4. Feeling tired or having little energy Not at all Several Days More than half the days Nearly every day 5. Poor appetite or overeating Not at all Several Days More than half the days Nearly every day 6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down Not at all Several Days More than half the days Nearly every day 7. Trouble concentrating on things, such as reading the newspaper or watching television Not at all Several Days More than half the days Nearly every day 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 usual Not at all Several Days More than half the days Nearly every day 9. Thoughts that you would be better off dead or of hurting yourself in some way Not at all Several Days 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 If you are human, leave this field blank. Submit
