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Thank you for onboarding with us and completing your face to face consultation with our prescribers.

Due to the nature of the therapy requested, we need you to complete some further paperwork. This form can be saved and continued later – if you don’t get time to do it all at once.

PHQ-9 Q1. Little interest or pleasure in doing things
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q2. Feeling down, depressed, or hopeless
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q3. Trouble falling or staying asleep, or sleeping too much
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q4. Feeling tired or having little energy
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q5. Poor appetite or overeating
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q7. Trouble concentrating on things, such as reading the newspaper or watching television
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q8. 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
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Q9. Thoughts that you would be better off dead or of hurting yourself in some way
Over the last 2 weeks, how often have you been bothered by this problem?
PHQ-9 Difficulty. 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 Q1. Feeling nervous, anxious or on edge
Over the last 2 weeks, how often have you been bothered by this problem?
GAD-7 Q2. Not being able to stop or control worrying
Over the last 2 weeks, how often have you been bothered by this problem?
GAD-7 Q3. Worrying too much about different things
Over the last 2 weeks, how often have you been bothered by this problem?
GAD-7 Q4. Trouble relaxing
Over the last 2 weeks, how often have you been bothered by this problem?
GAD-7 Q5. Being so restless that it is hard to sit still
Over the last 2 weeks, how often have you been bothered by this problem?
GAD-7 Q6. Becoming easily annoyed or irritable
Over the last 2 weeks, how often have you been bothered by this problem?
GAD-7 Q7. Feeling afraid as if something awful might happen
Over the last 2 weeks, how often have you been bothered by this problem?
Optional: add any relevant comments.