Healthy Campus Depression Screener

Three-Minute Depression Screening

The purpose of a depression screener is to provide a preliminary assessment of whether you may be experiencing symptoms of depression. It is not a diagnostic tool but can be a useful starting point for individuals who are concerned about their mental health and want to gauge their anxiety levels. This particular screener is based on the PHQ-9. The PHQ-9 is a self-administered tool with 9 items, drawing from the DSM-V criteria to pinpoint potential cases of depression and to gauge the intensity of symptoms.
Your name, your results, and whether or not you participated are confidential and will NOT be shared with your employer.
Select your School District*
Your school district is not currently offering the Healthy Campus Program. Please click this link to fill out a form and indicate your interest to the district.

Your Results

Below are the results from the PHQ-9 screener. These results are for informational purposes only until they are reviewed by a licensed healthcare provider.
PHQ-9 Score Calculation
PHQ-9 Score
As part of a district-wide wellness program, Healthy Campus and the Chula Vista Elementary School District are providing access to licensed healthcare providers. Would you like to speak with a provider at no cost? (the first two 30-minute visits are at no cost).*

Yes I am interestedNot at this time
Complete your assessment and receive your five-page "results and resource" guide by clicking the green button below.

Your results will not be saved if you do not submit.
Complete the following information to speak with a provider at no cost and to receive your five-page "results and resource" guide.

Your results will not be saved if you do not submit.
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Do you have health insurance? (including all commercial payers or Medi-Cal)*

YesNo - I do not have health insurance. I will call the uninsured program phone number now (909-287-1150).
Do you have Tri-Care Insurance?*

yesno
What is your Tri-Care Membership Number? (Note: this is NOT your DOD number).*
Please input the ID number provided to you when you called the uninsured program hotline.*
Please upload the front of your insurance card here: *

Cancelof
Please upload the back of your insurance card here: *

Cancelof
Please check this box if you would like to be contacted by Healthy Campus by phone, text, and/or email about scheduling your first visit with a provider.*

Yes - I would like to be contacted by Healthy Campus by phone, text, and/or email about scheduling my first visit with a provider.
By signing below...

I confirm I am the patient or have the authority to sign on behalf of the patient. If you are signing on behalf of a minor, by signing below you are representing that you are authorizing the administration of the services on behalf of the minor.
I consent to review my healthcare results via text or personal email and to communicate with my Provider via text or email. I understand that communications via text and email may be unsecured and have a greater risk of disclosure.
Signature*

Clear
Should be Empty:

	Not at all	Several days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
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
9. Thoughts that you would be better off dead or of hurting yourself in some way

Three-Minute Depression Screening

PHQ-9 Screening - Used to identify symptoms of depression.

Your Results

Complete your assessment and receive your five-page "results and resource" guide by clicking the green button below.

Complete the following information to speak with a provider at no cost and to receive your five-page "results and resource" guide.