This PHQ-9 printable PDF gives clinicians a ready-to-scan depression screening form with the 9 verbatim Patient Health Questionnaire items, a difficulty rating, name and date fields, and a staff scoring box. It prints on a single page and takes about two minutes to complete.
What this survey measures
The PHQ-9 screens for the presence and severity of depression over the previous two weeks. The nine grid items map directly to the diagnostic criteria for depressive disorders, covering mood, sleep, energy, appetite, concentration, self-worth, psychomotor changes, and thoughts of self-harm. A final question captures how much these problems interfere with work, home life, and relationships, and the staff section records the total severity score from 0 to 27, with a short scoring guide printed beside it.
How to use it on paper
Hand the form to patients in the waiting room, at intake, or during a primary care or behavioral health visit. Patients fill the checkboxes with a blue or black pen and return the sheet at reception. Collect the completed forms and scan them in batches: PaperSurvey reads every checkbox with optical mark recognition and posts the results to your dashboard, so no one retypes answers by hand.
Customize this template
Add your clinic logo, translate the questionnaire for your patient population, or add intake fields such as a patient ID or date of birth. Please keep the nine item statements exactly as written so the instrument stays valid. The paper layout reflows automatically as you edit, and every copy you print stays scannable.
The PHQ-9 was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission is required to reproduce, translate, display or distribute it.
Preview the PDF above, or use this template to start screening on paper today.