Follow-Up Assessment

PHQ-15 — Physical Symptoms

A validated 15-item tool measuring the severity of somatic symptoms over the past four weeks.

Used so Dr. Nicole can follow up with you.

During the past four weeks, how much have you been bothered by any of the following problems?

Symptom
Not bothered
(0)Bothered a little
(1)Bothered a lot
(2)
a. Stomach pain
b. Back pain
c. Pain in your arms, legs, or joints (knees, hips, etc.)
d. Menstrual cramps or other problems with your periods (Women only)
e. Headaches
f. Chest pain
g. Dizziness
h. Fainting spells
i. Feeling your heart pound or race
j. Shortness of breath
k. Pain or problems during sexual intercourse
l. Constipation, loose bowels, or diarrhoea
m. Nausea, gas, or indigestion
n. Feeling tired or having low energy
o. Trouble sleeping
Scoring Guide (clinician reference) Total 0–30 • 0–4 Minimal · 5–9 Low · 10–14 Medium · 15+ High somatic symptom severity

PHQ-15 developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.

You’ll be able to download or print your own copy after submitting.

✅  Assessment submitted successfully. Thank you.

Save this copy for your own records. Your submission has also been sent securely to Dr. Nicole.