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Personal Details

May be used to identify you

Patient Health Questionnaire (PHQ-9)

PHQ-9 Assessment Over the last 2 weeks, how often have you been bothered by any of the following problems?

(1) Little interest or pleasure in doing things?: *

(2) Feeling down, depressed, or hopeless?: *

(3) Trouble falling or staying asleep, or sleeping too much?: *

(4) Feeling tired or having little energy?: *

(5) Poor appetite or overeating?: *

(6) Feeling bad about yourself — or that you are a failure or have let yourself or your family down?: *

(7) Trouble concentrating on things, such as reading the newspaper or watching television?: *

(8) Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?: *

(9) Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?: *

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? : *

PHQ-9 Result 1 - 4 (Minimal Depression)

MINIMAL DEPRESSION - you have a score of

Scores < 4 suggest minimal depression which may not require treatment.

PHQ-9 Result 5 - 9 (Mild Depression)

MILD DEPRESSION - you have a score of

Scores 5 - 9 suggest mild depression.

You may benefit from our Health and Wellbeing service.

Contact the practice via our online form Klinik or call us on 0208 176 9110

PHQ-9 Result 10 -14 (Moderate Depression)

MODERATE DEPRESSION - you have a score of

Scores 10 - 14 suggest moderate depression severity.

You may benefit from Waltham Forest Talking Therapy Service.

Waltham Forest Talking Therapy Website

Talking Therapies Self Referral

Or contact us via our online form Klinik or call on 0208 176 9110 to arrange to speak to a GP

PHQ-9 Result 15 - 19 (Moderately Severe Depression)

MODERATELY SEVERE DEPRESSION - you have a score of

Scores 15 - 19 suggest moderately severe depression.

PHQ-9 Results 20 - 27 (Severe Depression)

SEVERE DEPRESSION - you have a score of

Scores 20 and greater suggest severe depression.

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Generalised Anxiety Disorder 7 (GAD-7)

GAD-7 AssessmentOver the last two weeks how often have you been bothered by the following problems?

(1) Feeling nervous, anxious, or on edge: *

(2) Not being able to stop or control worrying: *

(3) Worrying too much about different things: *

(4) Trouble relaxing: *

(5) Being so restless that it is hard to sit still: *

(6) Becoming easily annoyed or irritable: *

(7) Feeling afraid, as if something awful might happen: *

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? : *

GAD-7 Result 0 - 4 (No Anxiety Disorder)

NO ANXIETY DISORDER - you have a score of

Scores < 4 suggest No Anxiety Disorder.

GAD-7 Result 5 - 9 (Mild Anxiety)

MILD ANXIETY - you have a score of

Scores 5 - 9 suggest Mild Anxiety.

GAD-7 Result 10 - 14 (Moderate Anxiety)

MODERATE ANXIETY - you have a score of

Scores 10 - 14 suggest Moderate Anxiety.

GAD-7 Result 15 - 21 (Severe Anxiety)

SEVERE ANXIETY - you have a score of

Scores 15 - 21 suggest Severe Anxiety.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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