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Map of Fremantle Hospital
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Facilities
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Parking and transport
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Coming to Cockburn Health
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Visiting our hospitals
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Parking and transport
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Maps of Cockburn Health
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Visiting our hospitals
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Your hospital admission
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Ordering patient meals
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Elective surgery
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Patient rights
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Talk about 'What matters to you?'
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MySay healthcare survey
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Pastoral care
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Supporting carers
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Supporting Aboriginal patients and families
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Supporting patients with cognitive impairment
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Understanding delirium
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If you can't visit an older patient
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The intensive care journey
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After the loss of a loved one
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SMHS GP Engage
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Consumer Advisory Council
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'Put it to the People' engagement platform
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ED Consumer Advisory Group
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Mental Health Consumer Advisory Group (Fremantle Hospital)
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Home
Forms
BIMS-Patient-Health-Questionnaire
BIMS-Patient-Health-Questionnaire
BIMS-Patient-Health-Questionnaire
The link you have used to access this questionnaire is incorrect
All questions must be answered before the survey can be submitted. Your survey will be saved automatically when you have finished.
UniqueCode
PHQ-4
Patient Health Questionnaire - 4 for BIMS
PHQ-4 - BIMS
PHQ4Survey
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious or on edge
Not at all
Several days
More than half the days
Nearly every day
Not being able to stop or control worrying
Not at all
Several days
More than half the days
Nearly every day
Little interest or pleasure in doing things
Not at all
Several days
More than half the days
Nearly every day
Feeling down, depressed, or hopeless
Not at all
Several days
More than half the days
Nearly every day
Last Updated:
15/05/2026