The Patient Health Questionnaire (PHQ‐9)

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? *

Scoring: Not at All = 0 | Several Days = 1 | More Than Half the Days = 2 | Nearly Every Day = 3

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’re a failure or have let yourself or your family down

Trouble concentrating on things, such as reading the newspaper or watching TV

Moving or speaking so slowly that other people could have noticed. Or, the opposite ‐ being so fidgety or restless that you have been moving

Thoughts that you would be better off dead or hurting yourself in someway

Total Score:

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.