PHQ-9 Nashville Ketamine Center Name* First Last Date* MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Email* Over the last 2 weeks, how often have you been bothered by any of the following?(Please select the best answer)Little interest or pleasure in doing things:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayFeeling down, depressed, or hopeless:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayTrouble falling or staying asleep, or sleeping too much:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayFeeling tired or having little energy:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayPoor appetite or overeating:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayFeeling bad about yourself, or that you are a failure or have let yourself or your family down:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayTrouble concentrating on things, such as reading the newspaper, or watching television:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayMoving 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 AllSeveral DaysMore Than Half the DaysNearly Every DayThoughts that you would be better off dead or of hurting yourself in some way:*Not at AllSeveral DaysMore Than Half the DaysNearly Every DayIf you checked off any probblems, how difficult have these problems made it for you to do your work, take care of things at home, or to get along with other people?* Not Difficult at All Somewhat Difficult Very Difficult Extremely Difficult Δ
