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SANE
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Am I Pregnant?
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Start 4 Life
Smoking affects your unborn baby
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Your Contraception Guide
Sexual Health Services
Free Condoms
Gender Dysphoria
LGBT Foundation
Maria Stopes UK
Sexually Transmitted Disease
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Annual Health Check
Pneumococcal vaccine
Screening Services
Young People
Kooth
News
Menu
Home
Appointments & Prescriptions
Order a Repeat Prescription
Electronic Prescriptions
Register for Online Services
Appointments
Book an Appointment
Cancel an Appointment
Consulting Times
Extended Opening Hours
Get Immediate Help from Your Pharmacist
Help with your GP Appointment
Referral for Further Care
NHS e-Referral Tracking
Referral to Hospital by your GP
See a Doctor or Healthcare Professional
Tests & Investigations
Access your Test Results
X-Ray?
What is a Blood Test?
Clinics & Services
Clinics
Antenatal Care
Child Health Checks
Long Term Conditions
Vaccinations & Travel Advice
Flu Vaccination
Travel Vaccinations
Pneumococcal Vaccination
Shingles Vaccination
Vaccinations for Children & Babies
Practice Services
Advocacy Service
Dementia Services
Cervical Screening
Diabetes Services
Hepatitis B Immunisation
Housebound & Older People
Home Visits
Interpreting Service
NHS Services
The NHS Constitution for England
New Medicine Service (NMS)
Non NHS Services – Chargeable
Patient Transport Service
About Us
Contact & Location
Useful Contact Telephone Numbers
What to do when we are Closed
Subject Access Request (SAR)
Friends and Family Test
Making the Most of your Practice
Our Team
Doctors
Nurses
Practice Administration Team
Community Nurses
Visiting Professionals
Patient Voice
Patient Participation Group
The Friends of Sandford Surgery Constitution
Signing Up For Patient Participation Group
Patient Feedback & External Inspections
Care Quality Commission
Complaints Procedure
Compliments, Concerns & Suggestions
Friends & Family Test
Practice Policies
Accessibility
Access to your Health Records
Accessible Information Standard
Chaperones
Clinical Governance
Entitlement to NHS Treatment
Care Data
Clinical Research
Confidentiality
Consent Protocol
Disability Access
Duty of Candour
Equality and Diversity
Freedom of Information
General Practice Extraction Service (GPES)
Infection Control Statement
Named GP Policy
NHS Personal Information
Non-Smoking Premises
Patient Advice
Patient Advice and Liaison Service PALS
Removal of Patients From our List
Safeguarding Children
Summary Care Records (SCR)
NHS Patient Rights
Quality Assurance
Your Rights and Responsibilities
Privacy Policy
Sharing your Information with Others
Unacceptable Actions Policy
Website Terms and Conditions
Zero Tolerance
Regulations & Governance
Clinical Commissioning Group
GP Earnings
Administration
Get a Sick or Fit Note
Health Review Forms
Alcohol Consumption Review Form
Asthma Review Form
Blood Pressure Review Form
Breathlessness Review Form
Epilepsy Review Form
Mental Health Review (PHQ-9) Form
Smoking Review Form
Travel Risk Assessment Form
Register with us as a New Patient
Temporary Services
Registration Policy
Update your Personal Details Forms
Change of Contact Details Form
Register as a Carer Form
Summary Care Record Opt-out Form
Communication Consent Form
Your Health
Alcohol & Drug Services
Children’s Health
Children and young people’s Services
Change4Life
Childline
Triple P – Positive Parenting Programme
Your Guide to Coughs, Colds, Earache & Sore Throats for your Child.
Disability
Disability Rights UK
Autism
Contact – For Families with Disabled Children
Get active with a disability
How to Care for a Disabled Child
Deaf or Hard of Hearing
Learning Disability
National Autistic Society
SCOPE Equality for Disabled People
Vision Impairment
Local & Community Services
My health My way
LiveWell Dorset
Purbeck Pledge
Family Information Service
General Health Advice
Antibiotic Awareness
Diarrhoea and Vomiting – Dos and Don’ts
Managing your Infection
Help & Support
Care & Support
Age UK
Are you a Carer?
Bereavement
Cancer Support Services
Carers UK
End of Life Care
End of life care
Together for short Lives
Health Unlocked
Organ Donation
Orchid – Fighting Male Cancer
Penile Cancer
Same You
Together for Short Lives
The Brain Tumour Charity
Services for Carers
Health & Wellbeing
Food Allergy
Vitamin B12 or folate deficiency anaemia
Testicular Cancer – Check Yourself
Know Who to Turn to for Your Healthcare
Accident & Emergency
Dentist
Hospitals
NHS Out of Hours Services
Optician
Pharmacist
Lifestyle Changes
Healthy Eating
Physical Activity – The Single best Medicine
Social Prescribing
Weight Management
Stop Smoking Service
Long Term Conditions
Asthma
Breast Cancer (female)
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Heart Disease
Dementia
Dementia with Lewy bodies
Diabetes
Epilepsy
High Blood Pressure (Hypertension)
Osteoarthritis
Prostate Cancer
Menopause
Mental Wellbeing
Depression
Dealing with a Mental Health crisis or emergency
Feeling down or anxious? Beating the Blues 24/7 can help…
Making Space
Mind – For better Mental Health
Mental Health helplines
Mental Health – General Advice
Mental health issues if you’re gay, lesbian or bisexual
Rethink Mental Illness
Samaritans
SANE
Time to Change
Pregnancy & Baby
Am I Pregnant?
Maternity Services Locations
Postnatal depression
Start 4 Life
Smoking affects your unborn baby
Sexual Health & Sexuality
Contraceptive Advice & Sexual Health
Your Contraception Guide
Sexual Health Services
Free Condoms
Gender Dysphoria
LGBT Foundation
Maria Stopes UK
Sexually Transmitted Disease
Preventative Medicine
Annual Health Check
Pneumococcal vaccine
Screening Services
Young People
Kooth
News
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Mental Health Review (PHQ-9) Form
Sandford Surgery
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Mental Health Review (PHQ-9) Form
Mental Health Review (PHQ-9)
First Name
*
Last Name
*
Email
*
Enter Email
Confirm Email
*
Confirm Email
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Your Mental Health 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 so fidgety or restless that you have been moving 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 thoughts of hurting yourself in some way?
*
Not at all
Several days
More than half the days
Nearly every day
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?
*
Not at all
Several days
More than half the days
Nearly every day
PHQ-9 Score
Privacy Policy
This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our
Privacy Policy
to discover how we protect and manage your submitted data.
*
I consent to the practice collecting and storing my data from this form.
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