Mood & Anxiety Questionnaire (PHQ-9) & (GAD-7)

Please complete only if you have been advised by the surgery to submit a Patient Health Questionnaire (PHQ-9/GAD-7) please use this form. Each question has a SCORE

Last Updated: 02/03/2021

Your Details





PHQ-9

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










GAD-7

Over the last 2 weeks (or other agreed time period) How often have you been bothered by any of the following problems?








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This form collects your name, date of birth, email, other personal information and medical details. This is to confirm once you are registered with the practice you are allowing the practice team to contact you and also update your medical records. Please read our Privacy Policy to discover how we protect and manage your submitted data.