Regal Chambers Surgery

50 Bancroft, Hitchin, Herts SG5 1LL

Telephone: 01462 453232

E82075.regalchamberssurgery@nhs.net

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PHQ-9 Depression Questionnaire

PHQ-9 Depression Questionnaire

Full Name(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Email(Required)

Phone Number(Required)

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(Required)

Not at all

Several days

More than half the days

Nearly every day

Feeling down, depressed, or hopeless(Required)

Not at all

Several days

More than half the days

Nearly every day

Trouble falling or staying asleep, or sleeping too much(Required)

Not at all

Several days

More than half the days

Nearly every day

Feeling tired or having little energy(Required)

Not at all

Several days

More than half the days

Nearly every day

Poor appetite or overeating(Required)

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(Required)

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(Required)

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 the opposite — being so fidgety or restless that you have been moving around a lot more than usual(Required)

Not at all

Several days

More than half the days

Nearly every day

Thoughts that you would be better off dead or of hurting yourself in some way(Required)

Not at all

Several days

More than half the days

Nearly every day

Score(Required)

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?(Required)

Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

Comments

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17926

Opening Times

Monday
08:00am to 06:30pm
Phone lines closed 13.00-14.30
Tuesday
08:00am to 12:30pm
02:00pm to 06:30pm
Wednesday
08:00am to 06:30pm
Phone lines closed 13.00-14.30
Thursday
08:00am to 06:30pm
Phone lines closed 13.00-14.30
Friday
08:00am to 06:30pm
Phone lines closed 13.00-14.30
Saturday
CLOSED
Sunday
CLOSED

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How many per day?*

Name

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35632

Friends & Family Test

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We would like you to think about your recent experiences of our service.

Thinking about your recent visit, overall, how was your experience of our service?*

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Please can you tell us why you gave your answer?

Phone

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18290

Travel Risk Assessment

Important Notice: New Process for Requesting Travel Vaccinations

To ensure timely and effective travel vaccinations, we are implementing a new process. Please be aware of the following important changes:

Minimum Notice Required: You must request travel vaccinations at least 6 weeks before your travel date. If requests are made with less than 6 weeks’ notice, it may not be possible to accommodate you at the surgery, and you will be directed to a private provider.
How to Submit Your Request:
- Use our online tool, AccuRx, to submit an admin query for travel vaccinations.
- Occasionally, the ability to make an appointment via the online consultation tool may be temporarily suspended. Patients are still able, however, to submit an admin query.
Travel Questionnaire:
- Once your admin query is received, a member of our team will send you a travel questionnaire to complete and return.
- If you are travelling with family members registered at our surgery, each individual must submit a separate admin query and complete a questionnaire.

Thank you for your cooperation and understanding.

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