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PHQ-2 & PHQ-9
GAD-2 & GAD-7
OPIOID RISK TOOL
PATIENT CONTRACT
CPT 96127

Patient Health Questionnaire

PHQ-2 and PHQ-9

The PHQ-2 is used as an initial screen for depression. Depending on your answers, you may be asked to complete the PHQ-9, which includes 7 additional questions.

PHQ-2
PHQ-2 & PHQ-9

Over the last 2 weeks, how often have you been bothered by the following problems?

1.  Little interest or pleasure in doing things

2.  Feeling down, depressed, or hopeless

No further screening necessary
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More screening is needed to understand your answers. Please complete the following 7 questions.

3.  Trouble falling asleep, 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’re 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

Complete Questionnaire
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Your score indicates that you may have
Moderate Depression
If you are taking this at the request of your doctor, please address these results with your provider.
If you are taking this on your own, learn more about next steps here.
Review and print
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The following patient completed the PHQ on xx/xx/xxxx. at xx:xx local time. CPT 96127

PHQ-2 & PHQ-9

Result: 5 - Moderate Depression

Patient Name:

DOB:

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Little interest or pleasure in doing things
N/A   
Feeling down, depressed, or hopeless
N/A
Trouble falling asleep, staying asleep, or sleeping too much
N/A 
Feeling tired or having little energy
N/A 
Poor appetite or overeating
N/A
Feeling bad about yourself - or that you’re a failure or have let yourself or your family down
N/A  
Trouble concentrating on things, such as reading the newspaper or watching television
N/A  
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
N/A  
Thoughts that you would be better off dead or of hurting yourself in some way
N/A