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Home > PHQ-9 and GAD-7 and SWEWBMS – Networks

Please fill this form out

Please copy and paste the Network ID. This is a combination of letters and numbers provided by your facilitator. It looks like this: 0064J00000JdBoe
Between the first and the last intervention please select "Mid Event"

Filling out the following questionnaires will help us to determine the right kind of support for you, if you would prefer to discuss them with a member of our team please leave them blank and submit your referral

Below are some statements about feelings and thoughts.

Please enter the number that best describes your experience of each over the last 2 weeks based on the below:

  1. = None of the time
  2. = Rarely
  3. = Some of the time
  4. = Often
  5. = All of the time
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.

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

Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself - or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
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
Thoughts that you would be better off dead or of hurting yourself in some way

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

Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Worrying to much about different things
Trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen

Please select from the options below if you think that the description applies to you most of the time and in most situations.

In general, do you have difficulty making and keeping friends?
Would you normally describe yourself as a loner?
In general, do you trust other people?
Do you normally lose your temper easily?
Are you normally an impulsive sort of person?
Are you normally a worrier?
In general, do you depend on others a lot?
In general, are you a perfectionist?

For decorative purposes only