Patient Health Questionnaire (PHQ-9)

If you have been advised by the surgery to submit a Patient Health Questionnaire (PHQ-9) please use this form.

Patient Health Questionnaire (PHQ-9)

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.


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

For the following situations, please state how likely you are to avoid them using the following scores: 0 - Never avoid it, 2 - Slight Avoid it, 4 - Definitely Avoid it, 6 - Markedly Avoid it, 8 - Always Avoid it