Health Screening Questionnaire for Depression

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Name
Date of Birth:
Date:

Over the past two weeks, how often have you been bothered by any of the following problems? 

Scoring

TOTAL:: 0
TOTAL:: 0
TOTAL:: 0
TOTAL:: 0
Add the previous four totals together to get your overall score
Total

PHQ = Patient Health Questionnaire. Adapted from Patient Health Questionnaire (PHQ) screeners (http://www:phqscreeners.com). Accessed February 8, 2018.