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PHQ-9 Depression Screening

1 page•13 fields
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Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

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PHQ-9 Depression Screening

Page 1 of 1

Patient Name
Jane Martinez
Date of Birth
03/15/1985
Date
03/15/1985
1. Little interest or pleasure in doing things
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
2. Feeling down, depressed, or hopeless
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
3. Trouble falling or staying asleep, or sleeping too much
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
4. Feeling tired or having little energy
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
5. Poor appetite or overeating
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
7. Trouble concentrating on things, such as reading the newspaper or watching television
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
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
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
9. Thoughts that you would be better off dead, or of hurting yourself in some way
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
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
Submit
Use this template

Sign up and start customizing in minutes.

Start with the PHQ-9 Depression Screening template and tailor it to your practice. It includes 13 editable fields across 1 page. Included questions: Patient Name, Date of Birth, Date, 1. Little interest or pleasure in doing things. The full field list below shows what you will get when you add this template to your account.

Choose this template to open an editable form. Review the questions, keep only the information your practice needs, and add your branding. Preview the patient experience before sharing a link or embedding the form. Responses can be reviewed in Formisoft and exported as a PDF.

Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

What's included

  • Patient Name
  • Date of Birth
  • Date
  • 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 of 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?

Who uses this template

  • Primary care annual depression screening
  • Behavioral health intake and follow-up
  • Medication management monitoring
  • Clinical research and quality measurement

All form fields

13 fields across 1 page. Customize any field after signing up.

Patient NameText
Date of BirthDate
DateDate
1. Little interest or pleasure in doing thingsMultiple Choice
2. Feeling down, depressed, or hopelessMultiple Choice
3. Trouble falling or staying asleep, or sleeping too muchMultiple Choice
4. Feeling tired or having little energyMultiple Choice
5. Poor appetite or overeatingMultiple Choice
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family downMultiple Choice
7. Trouble concentrating on things, such as reading the newspaper or watching televisionMultiple Choice
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 usualMultiple Choice
9. Thoughts that you would be better off dead, or of hurting yourself in some wayMultiple Choice
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?Multiple Choice

How to use the PHQ-9 Depression Screening

Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the PHQ-9 Depression Screening from the template library. Review the included questions, customize your fields, and preview the form before sharing it.

Setup steps

  1. 1Choose the template. Find the PHQ-9 Depression Screening in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 13 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

How does Formisoft protect responses?

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 13 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

With a plan that includes automation, you can configure workflows to send forms and reminders. Appointment-based sending requires the booking event to reach Formisoft.

Does this template work on mobile devices?

Yes. The PHQ-9 Depression Screening is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

Start with this template

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