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PHQ-9 Depression Screening

Inland Empire Behavioral Group Nursing Corp.

About 3 minutes

A short, nine-question screening that helps your provider understand how you've been feeling over the past two weeks.

Layout preview. The live form will be hosted by our HIPAA-compliant intake partner. This page is for design review only and does not submit anything.

Over the last two weeks, how often have you been bothered by any of the following problems? Choose the answer that best describes you.

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling asleep, staying asleep, or 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 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 usual)

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

10. If you checked off any problems above, 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?

Your responses go directly to your provider. The score is calculated automatically and is visible only to your provider.

Having trouble with the form? Give us a call at (909) 300-0661. We're happy to help.

Your information is encrypted and submitted securely through our HIPAA-compliant intake partner. It isn't stored on this website.