Depression Screening

If you have been experiencing difficulties with your mood, answer the questions below. Upon completion of the screening you may call to request a complimentary consultation to discuss this screening. All information will be kept private and confidential.

If you are currently experiencing a mental health crisis, such as suicidal ideation and/or homicidal ideation; please seek immediate attention by contacting the mobile crisis line 901-577-9400, visiting your nearest emergency room, or calling 911.

By submitting this form you acknowledge understanding the completion of the PHQ-9 tool is not a diagnosis of depression and is solely used for
purposes of identifying symptoms.


Over the last 2 weeks, how often have you
been bothered by any of the following problems?
Not at all
Several Days
More than half
the days
Nearly every day
1. Little interest or pleasure in doing things
2. Feeling down, depressed , or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself – or that you are a failure or have let
yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper
or watching television
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
9. Thoughts that you would be better off dead or hurting yourself
in some way

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?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

=


Depression score ranges:
1-4 = minimal
5-9 = mild
10-19 = moderate
20+ = severe

If you would like to receive a complimentary consultation, please contact me at 901-654-0607. Please allow 24hrs for a return call.




PHQ-9 screening courtesy of Pfizer. No permission required to reproduce, translate, display, or distribute.