Patient Health Questionnaire-9 (PHQ-9)

This form is intended for new and existing patients.  Please note that you should complete/submit this form on the day of your appointment, and it will be reviewed by Dr. Bird immediately before your already-scheduled appointment.  

If you are a current patient and have an urgent clinical concern that requires attention before your scheduled appointment, please call the office at 828-232-1994. 

Over the last 2 weeks, how often have you been bothered by any of the following problems?
0— Not at all
1— Several days
2— More than half the days
3— Nearly every day

1. Little interest or pleasure in doing things
0123

2. Feeling down, depressed, or hopeless
0123

3. Trouble falling or staying asleep, or sleeping too much
0123

4. Feeling tired or having little energy
0123

5. Poor appetite or overeating
0123

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
0123

7. Trouble concentrating on things, such as reading the newspaper or watching television
0123

8. Moving 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
0123

9. Thoughts that you would be better off dead or of hurting yourself in some way
0123

If you checked off 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?
N/ANot at all difficultSomewhat difficultVery difficultExtremely difficult