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Hannage Brook Medical Centre NHS GP Surgery in Wirksworth Derbyshire

Patient Health Questionnaire (PHQ-9)

Patient Health Questionnaire (PHQ-9)

Who are you completing this form for?

For example, on behalf of a child or dependent

Yourself

Someone else

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

Social situations due to a fear of being embarrassed or making a fool of myself

0

1

2

3

4

5

6

7

8

Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness)

0

1

2

3

4

5

6

7

8

Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying)

0

1

2

3

4

5

6

7

8

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

If you are human, leave this field blank.

The Practice Is Currently Closed.

This form is not currently available when the practice is closed. To get the healthcare support you may need out of hours, please speak to your local pharmacist, contact NHS 111, or the Whitworth Walk in centre, please call 999 for medical emergencies.

Thank you, Hannage Brook Medical Centre.

Hannage Brook Medical Centre
Hannage Way
Water Lane
Wirksworth
Derbyshire DE4 4JG

Get directions

01629 822434

Hannage Brook Medical Centre

CQC overall rating

Outstanding

7 April 2017

See the report

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