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🌿 Therapy & Mental Wellness

Free Depression Self-Check Template

Free PHQ-9-style depression self-check — nine 2-week symptom items scored 0-3, with a personalized AI report explaining severity bands, not a diagnosis.

~5 min
9 scored items
AI PDF Report
AI Consultant
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Free PHQ-9-style depression self-check — nine 2-week symptom items scored 0-3, with a personalized AI report explaining severity bands, not a diagnosis.

Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified professional when needed.

Methodology: items are a structural adaptation of widely used frameworks, not an official version; scoring is indicative, not diagnostic.

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About this template

Nine questions about the last two weeks, answered 0-3, give you and the client a shared picture of where depressive symptoms sit right now. This check adapts the widely used PHQ-9 structure with its own wording, maps totals to published severity bands as indicative context, and generates a plain-language AI report — including immediate support guidance if the self-harm item is endorsed.

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Live Preview

Sample form and AI report preview (fillable once the app is published).

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Fill it in to see how responses flow.
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Sample AI report with scoring visuals and recommendations, printable as a PDF.
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Scan the QR on the report to start an AI consultant chat.
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What's Included

The nine PHQ-9-style items and their indicative bands.

1

Nine anchored items

0-3 frequency wording over the last two weeks.

2

Severity band mapping

Total score placed in published range bands — indicative only.

3

AI report in plain language

Explains which items lifted the score and what the band means.

4

Help guidance

High item-9 responses direct toward immediate professional contact.

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How It Works

From copy to a scored depression check in four steps.

1

Copy the template

Import form, scoring and report settings — free.

2

Adjust wording if needed

Keep the nine anchors or adapt items for your population.

3

Client completes it

Share the link; about five quiet minutes.

4

Read the report together

Open the AI PDF and use severity bands to plan next steps.

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Who Is This For

Who screens — individuals, students or clinicians.

1

Therapists & prescribers

Start sessions with a shared, structured picture.

2

Individuals self-reflecting

Understand their two-week state before seeking help.

3

Campus & workplace services

A consistent, private self-check conversation starter.

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Key Features

What makes this PHQ-9-style check careful and clear.

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Sample Questions Inside

The nine PHQ-9-style items in full view — the live check maps the total to indicative severity bands and returns a plain-language AI report.

  1. Little interest or pleasure in doing things (0-3)
  2. Feeling down, depressed or hopeless (0-3)
  3. Trouble falling or staying asleep, or sleeping too much (0-3)
  4. Feeling tired or having little energy (0-3)
  5. Poor appetite or overeating (0-3)
  6. Feeling bad about yourself, or that you are a failure (0-3)
  7. Trouble concentrating on things (0-3)
  8. Moving or speaking slowly, or being fidgety (0-3)
  9. Thoughts that you might be better off not being here, or of hurting yourself (0-3)
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Frequently Asked Questions

Is this the official PHQ-9?
No — it is a structural adaptation of the widely used nine-item framework. The original PHQ-9 is published by Pfizer under specific conditions; this template carries adapted wording, and the scoring shown is indicative, not an official instrument administration.
What do the score bands mean?
Totals of 0-4, 5-9, 10-14, 15-19 and 20-27 are commonly described as minimal, mild, moderate, moderately severe and severe — but a band is not a diagnosis; only a qualified clinician can assess depression.
What if item 9 is endorsed?
The report treats any non-zero on the self-harm item seriously: it directs to contacting a crisis line or emergency services now, alongside professional follow-up.
Can I use this with clients every few weeks?
Yes — retaking and comparing reports over time is a core strength of a digital form; track direction, not single scores.
Is it free to use?
Yes — copy the check, scoring and AI report configuration into your FormLM workspace at no cost.
Does the AI report diagnose?
No. It explains the pattern in the responses in plain language and suggests what to discuss with a professional.

Nine items, a clear picture, a printable report

Run a PHQ-9-style self-check with personalized AI interpretation — free to copy.