Patient Health Questionnaire for Depression (PHQ-9)

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

The Patient Health Questionnaire for Depression (PHQ-9) is a nine-question instrument given to patients in a primary care setting to screen for the presence and severity of depression.

Your score in the second section of the questionnaire does not affect that of the first section.

Patient Health Questionnaire for Depression (PHQ-9)

About You

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

Review

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

All three questions below are marked on a scale of 0-8 depending on how much you avoid the circumstances described, shown below. You can choose a number from the summarised scale below, then recording the number.

0 = Would not avoid it, 2 = Slightly avoid it, 4 = Definitely avoid it, 6 = Markedly avoid it, 8 = Always avoid it.

Your score in this section does not affect that of the first section of the questionnaire.