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Out of hours: 028 2566 3500
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Larne Medical Practice
Menu
Home
About Us
Contact
Contact Telephone Numbers
Location
Send a Message
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Opening Hours
What to do when we are closed
Practice History
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Teenage Friendly
Trainees & Medical Students
Website
Privacy
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral to Hospital by your GP
Who should I see?
Tests & Investigations
Clinics
Travel Clinic and Holiday Vaccinations
Practice Services
Forms
Downloadable Forms
Keep us up to Date
Health Review Forms
Help & Support
Help & Support Organisations
Guidance and bookings for vaccinations in Northern Ireland
Who can help me?
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Mental Health Review (PHQ-9) Form
Mental Health Review (PHQ-9) Form
Mental Health Review (PHQ-9)
First Name
*
Last Name
*
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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Home
About Us
Contact
Contact Telephone Numbers
Location
Send a Message
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Opening Hours
What to do when we are closed
Practice History
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Teenage Friendly
Trainees & Medical Students
Website
Privacy
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral to Hospital by your GP
Who should I see?
Tests & Investigations
Clinics
Travel Clinic and Holiday Vaccinations
Practice Services
Forms
Downloadable Forms
Keep us up to Date
Health Review Forms
Help & Support
Help & Support Organisations
Guidance and bookings for vaccinations in Northern Ireland
Who can help me?
News