Patient Health Assessment (PHQ-9)

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

Last Updated: 22/02/2023

Date of Birth Required



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

Little interest or pleasure in doing things Required
Feeling down, depressed, or hopeless Required
Trouble falling or staying asleep, or sleeping too much Required
Feeling tired or having little energy Required
Poor appetite or overeating Required
Feeling bad about yourself — or that you are a failure or have let yourself or your family down Required
Trouble concentrating on things, such as reading the newspaper or watching television Required
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 Required
Thoughts that you would be better off dead or of hurting yourself in some way Required
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Required



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


This Form Collects Your Name, Date of Birth, Email, Other Personal Information and Medical Details. This is to Confirm You Are Registered With the Practice, to Allow the Practice Team to Contact You and Also to Update Your Medical Records Held by the Practice and Our Partners in the Nhs. Please Read Our Privacy Policy to Discover How We Protect and Manage Your Submitted Data. 

Consent Required