Depression Screening (PHQ-9) - Silver Lining Clinics by MoodRx LLC

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Name

First

Last

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Phone

Date of Birth:

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling asleep, staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself—or that you are a failure or have let yourself or your family down

Trouble concentrating on things, such as reading or watching television

Moving or speaking so slowly that other people could have noticed, or the opposite—being fidgety or restless

Thoughts that you would be better off dead or of hurting yourself in some way