Before Your Visit
Please answer the following questions
Is your insurance the same as your last visit?
Would you like to see the doctor before your Spravato session today?
Have any of your demographics changed since your last visit?
(Address, phone number, email, etc.)
PHQ-9 Assessment
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Scoring Guide: 0 = Not at all · 1 = Several days · 2 = More than half the days · 3 = Nearly every day
1Little interest or pleasure in doing things
2Feeling down, depressed, or hopeless
3Trouble falling or staying asleep, or sleeping too much
4Feeling tired or having little energy
5Poor appetite or overeating
6Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7Trouble concentrating on things, such as reading the newspaper or watching television
8Moving 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
9Thoughts that you would be better off dead or of hurting yourself in some way
0
PHQ-9 Total Score
Minimal Depression
