Somatic Sympton PHQ-15 Assessment
You can respond anonymously, and no data will be retained from this assessment. If you choose to include your initials and an email address, your results will be automatically sent to the email address provided. Please check that the email address has been entered correctly before submitting this form. All client information is managed on a strictly confidential basis. Please Note: Whilst every effort is made to ensure that our system is securely encrypted, email is not a completely secure means of communication. Think CBT does not accept liability for loss or theft of personal data where any individual chooses to transmit or receive information via email.
Send my assessment results by email:
Initials:
Email:

This questionnaire is not designed to provide a definitive psychological diagnosis or to take the place of a professional consultation. Please answer all questions as accurately and honestly as possible.

During the past 7 days how much have you been bothered by any of the following problems?
1. Stomach pain
     
2. Back pain
     
3. Pain in your arms,legs, or joints (knees,hips, etc)
     
4. Menstrual cramps or other problems with your period (women only)
     
5. Headaches
     
6. Chest pain
     
7. Dizziness
     
8. Fainting spells
     
9. Felling your heart pound or race
     
10. Shortness of breath
     
11. Pain or problems during sexual intercourse
     
12. Constipation, loose bowels or diarrhea
     
13. Nausea, gas or indigestion
     
14. Feeling tired or having low energy
     
15. Trouble sleeping