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Run: PHQ-9 Depression Screening and Scoring Form

PHQ-9 Depression Screening and Scoring Form for intake and follow-up visits. Capture symptom responses, calculate a total score, and document next steps with...

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Screening Context

Screening date (required)

Screening type (required)

Patient ID (required)

Use the organization’s internal identifier. Do not collect SSN or other unnecessary PII.

Completed by

Optional staff name or role for audit trail purposes.

Consent and disclosure acknowledged (required)

Confirm that the patient was informed this screening collects health information for care coordination, documentation, and clinical review.

Yes No N/A

PHQ-9 Symptom Questions

1. Little interest or pleasure in doing things (required)

2. Feeling down, depressed, or hopeless (required)

3. Trouble falling or staying asleep, or sleeping too much (required)

4. Feeling tired or having little energy (required)

5. Poor appetite or overeating (required)

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down (required)

7. Trouble concentrating on things, such as reading the newspaper or watching television (required)

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 (required)

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

If this item is positive, follow your organization’s safety protocol immediately.

Scoring and Clinical Interpretation

PHQ-9 total score

Severity level

Suicidal ideation follow-up completed

Yes No N/A

Clinical notes

Document any relevant observations, treatment changes, or follow-up plan. Avoid unnecessary PII.

Get your results

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Email (required)

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