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May we leave voice messages pertaining to your condition and our treatment at the number you've provided on this form?*

 Yes No

May we email you information pertaining to your condition and our treatment at the email address you've provided on this form?*
 Yes No

The Patient Health Questionnaire (PHQ-9)

This is a confidential depression assessment. This website operates on a secure server (SSL protected) and has sitelock web security so all information you provide is encrypted, HIPAA compliant, and safe. We never share your information with 3rd parties.

A copy of your results will be sent to you and to Ketamine Clinics of Los Angeles. Should your score indicate you are depressed, we may contact you to discuss available treatment options, including but not limited to Ketamine Infusion Therapy.

Personal Information

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

1. Little interest or pleasure in doing things *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
2. Feeling down, depressed or hopeless *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
3. Trouble falling asleep, staying asleep, or sleeping too much *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
4. Feeling tired or having little energy *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
5. Poor appetite or overeating *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
7. Trouble concentrating on things, such as reading the newspaper or watching television *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
8. 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 *
Not At All
Several Days
More Than Half the Days
Nearly Every Day
9. Thoughts that you would be better off dead or of hurting yourself in some way *
Not At All
Several Days
More Than Half the Days
Nearly Every Day

10. If you checked off any problems, how difficult have those problems made it for you to Do your work, take care of things at home, or get along with other people? *
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult

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Contact Us

Ketamine Clinics of Los Angeles
11645 Wilshire Blvd., Suite 852
Los Angeles, CA 90025
P: 310-270-0625
F: 310-730-5993
Monday - Friday: 9:00 am - 5:00 pm
Ketamine Clinics of Los Angeles Location