PHQ-9 ConsentPHQ-9 CONSENT"*" indicates required fieldsThe 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.PHQ-9 CONSENT* I agree to the abovePatient Name* First Last Date of Birth*Signature*Reset signature Signature locked. Reset to sign again Today's Date*CAPTCHANameThis field is for validation purposes and should be left unchanged.
