Flagstaff Family Physicians, P.C -Robert Yee, M.D.

Available Forms

Alcohol Questionnaire- AUDIT -C *new patient form* Depression Health Questionnaire (PHQ-9) *new patient form* HIPAA *new patient form* Intake Questionnaire *new patient form* Medical Records Release *new patient form* Medicare Wellness Survey (Medicare Required) Patient Registration Form *new patient form* Payment Policy *new patient form* Physical Exam Form Required

Depression Health Questionnaire (PHQ-9) new patient form

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure doing things *

Feeling down, depressed or hopeless *

Trouble falling or staying asleep, or sleeping too much *

Feeling tired or having little energy *

Poor appetite or overeating *

Feeling bad about yourself-or that you are failure or have let yourself or your family down *

Trouble concentrating on things, such as reading the newspaper or watching TV *

Moving 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. *

Thoughts that you woulbe be better off dead or of hurting yourself in some way *

Total Score *

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? *

* Required field