PHQ-9 Teens Form Template

The PHQ-9 form is a Patient Health Questionnaire (PHQ) with 9 questions designed to screen for depression and suicidal ideation. The modified teen form is designed for patients ages 12 though 18. Teens can now submit this form electronically from their phone, tablet, or computer – allowing them the time and privacy to complete these very personal questions prior to an appointment.
PHQ-9-Modified-for-Teens

PHQ-9 Form Modified for Teens

Give your teen patients the freedom to complete the PHQ-9 Modified for Teens form with any device, anywhere. Ensure that teens are comfortable and respond privately by setting up your form online.

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What is a PHQ-9 Modified for Teens Form?

This form includes 9 targeted questions to assess symptoms of depression and suicidal intent. By consistently screening patients, at-risk teens can be identified and helped with an appropriate treatment plan.  

Early detection is a critical prevention strategy. The majority of people who die by suicide visit a healthcare provider within months before their death. This represents a tremendous opportunity to identify those at risk and connect them with mental health resources.

The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.

A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.

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Custom Logo and Branding

Custom Logo, Brand, and Styling

Add your logo to your forms and set the colors to match your brand. Pick the background of your forms, customize the gradient of your buttons, and select the field text color.

Resend HIPAA Compliant Forms

Resend HIPAA Compliant Forms

Resend completed patient intake forms. Patients will simply update what has changed, and leave the rest of the form completed.

Print HIPAA Compliant Submissions

Print HIPAA Compliant Form Submissions

Print your patients’ submissions after the forms have been completed online. Adjust the formatting and text size to match your original paper forms.

Encrypted PHI

Encrypted PHI ePHI

All PHI is encrypted in transit and at rest—while being submitted back to your account and at rest in our database. Protect sensitive data with fully encrypted patient submissions.

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FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:

  • Are having patients fill out paper forms during the appointment
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