PHQ-9 Consent


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The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental health disorders.

The PHQ-9 is a multipurpose instrument for screening, diagnosing, and monitoring / measuring the severity of depression.

I understand my insurance does not cover the cost of a PHQ9 depression screening questionnaire, or I am uninsured, so I will be paying for the cost of this questionnaire. I consent to be charged for the cost of this depression screening questionnaire on my next statement. The cost is between $15 - $30 each time I complete the questionnaire.

Patient Name*
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