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Patient
Patient Portal
Online Bill Pay
Patient Forms
About
PAKC News
Services
TMS
Spravato®
Medication Management
Contact
Appointment Check In
Patient Portal
The Patient Health Questionnaire (PHQ‐9) ‐ Overview
Patient Name
Date
Over the past 2 weeks, how often have you been bothered by any of the following problems? *
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 asleep, 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’re 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 the newspaper or watching TV
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, the opposite ‐ being so fidgety or restless that you have been moving
Not at All
Several Days
More Than Half the Days
Nearly Every Day
Thoughts that you would be better off dead or hurting yourself in someway
Not at All
Several Days
More Than Half the Days
Nearly Every Day
Total Score:
0
If your score on the PHQ-9 is 19 or more then you may be eligible for TMS treatment.
If you checked off any problems, how difficult have those problems 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
First Name
Last Name
Phone
Email Address
Your Psychiatrist
Our TMS staff will reach out to you to answer your questions regarding TMS and gather additional information from you prior to setting up a consulation.
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