Patient Health Questionnaire (PHQ-9)

What is your name?

First name

Last name

What is your date of birth?

For example, 31 3 1980

Day

Month

Year

What is your sex?

As recorded on your medical record

Male

Female

Other

What is your postcode?

The one used to register with your GP

What is your phone number?

What is your email address?

Anyone else with access to your email account may see responses sent to you

Review

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

Little interest or pleasure in doing things:

Not at all

Several days

More than half the days

Nearly every day

Feeling down, depressed, or hopeless:

Not at all

Several days

More than half the days

Nearly every day

Trouble falling or staying asleep, or sleeping too much:

Not at all

Several days

More than half the days

Nearly every day

Feeling tired or having little energy:

Not at all

Several days

More than half the days

Nearly every day

Poor appetite or overeating:

Not at all

Several days

More than half the days

Nearly every day

Feeling bad about yourself — or that you are a failure or have let yourself or your family down:

Not at all

Several days

More than half the days

Nearly every day

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

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

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

Please answer the following questions using the following scale: 0 – never avoid it, 2- slightly avoid it, 4 – definitely avoid it, 6 – markedly avoid it, 8 – always avoid it

Confirmation

I confirm that the information provided is accurate to the best of my knowledge

Terms and Conditions: Required

I confirm that this problem is not an emergency. I understand that the practice will not deal with this problem while the practice is closed.

If the problem worsens and may require immediate help, I will visit NHS 111 Online or call 111. In an emergency, I will call 999.

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Patient Health Questionnaire (PHQ-9)

Review

Temporary Suspension