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Home > Patient Health Questionnaire (PHQ-9)

Patient Health Questionnaire (PHQ-9)

Your Details

DD/MM/YYYY
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Your Contact Details

Over the last 2 weeks, how often have you been bothered by any of the following problems?
Over the last 2 weeks, how often have you had little interest or pleasure in doing things
Over the last 2 weeks, how often have you felt down, depressed, or hopeless
Over the last 2 weeks, how often have you had trouble falling/staying asleep, sleeping too much
Over the last 2 weeks, how often have you been feeling tired or having little energy
Over the last 2 weeks, how often have you had poor appetite or been overeating
Over the last 2 weeks, how often have you been feeling bad about yourself or that you are a failure or have let yourself or your family down
Over the last 2 weeks, how often have you had trouble concentrating on things, such as reading the newspaper or watching television.
Over the last 2 weeks, how often have you experienced 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.
Over the last 2 weeks, how often have you had thoughts that you would be better off dead or of hurting yourself in some way.

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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Paragon Practice

215 Kirkham Road, Freckleton, Lancashire, PR4 1HG

  • 01772 123456
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Local Services
Macmillan
Cancer Support