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PHQ-9 Rating Scale Form Template

Streamline Depression Evaluation with Our PHQ-9 Form

Managing patient assessments can be overwhelming, especially when evaluating depression. Our PHQ-9 Rating Scale Form Template is designed for healthcare professionals looking to simplify the collection of vital mental health data. With this template, you can efficiently assess your patients' depression levels, ensure accurate tracking over time, and promote better mental health outcomes. Experience the benefits of customizable fields, automatic scoring, and secure data handling, all while being compliant with HIPAA and WCAG standards. Try using the live template to see how it works for you.

Your full name
Today's date
I understand this is a self-screening tool and not a diagnosis. If I have urgent concerns, I will seek immediate help.
Yes
No
Little interest or pleasure in doing things
Not at all
Several days
More than half the days
Nearly every day
Feeling down, depressed, or hopeless
Not at all
Several days
More than half the days
Nearly every day
Trouble falling or staying asleep, or sleeping too much
Not at all
Several days
More than half the days
Nearly every day
Feeling tired or having little energy
Not at all
Several days
More than half the days
Nearly every day
Poor appetite or overeating
Not at all
Several days
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 days
More than half the days
Nearly every day
Trouble concentrating on things, such as reading or watching television
Not at all
Several days
More than half the days
Nearly every day
Moving or speaking so slowly that other people could have noticed, or 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
Thoughts that you would be better off dead, or thoughts of hurting yourself in some way
Not at all
Several days
More than half the days
Nearly every day
If you checked any problems above, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Email address
Phone number
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Paper art illustration of PHQ-9 Rating Scale Form Template for mental health assessment and evaluation.

When to use this form

In clinics, counseling centers, and telehealth, use this questionnaire to screen for depression, set a baseline, and track change. Example: at a first visit, you administer it before intake, then repeat after two weeks to measure response to therapy or meds. Use it during annual checkups to flag risk and guide follow-up. Pair it with a Biopsychosocial assessment form to capture history and stressors. If trauma symptoms surface, add the PTSD Checklist - civilian version (PCL-C) form to differentiate trauma-related distress. Between sessions, ask clients to log mood and triggers in a Mental health journal form to spot patterns. This short workflow helps you triage, prioritize safety, and communicate severity in clear numbers your whole team can act on.

Must Ask PHQ-9 Rating Scale Questions

  1. Over the last 2 weeks, how often have you had little interest or pleasure in doing things?

    Loss of interest signals core depression and predicts functional impact. Your answer shows whether to start or adjust treatment and what activities to reintroduce in your plan.

  2. Over the last 2 weeks, how often have you felt down, depressed, or hopeless?

    This captures mood severity and persistence. It helps you and your clinician see trends over time and weigh therapy, medication, or both.

  3. Over the last 2 weeks, how often have you had trouble falling or staying asleep, or slept too much?

    Sleep problems drive mood and can mask other conditions. If substances may play a role, pair screening with an Alcohol and drug evaluation form to target support.

  4. Over the last 2 weeks, how often have you had thoughts that you would be better off dead or of hurting yourself in some way?

    Any level of self-harm thinking is a safety issue. A positive response triggers a same-day risk assessment, safety planning, and rapid follow-up.

  5. If you checked 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?

    This gauges how symptoms affect work, home, and relationships. It guides level-of-care decisions and helps document medical necessity.

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