Self Referral Form

Personal Details

Your Own Reactions Now to the Grenfell Tower Fire

Please consider the following reactions which sometimes occur after the Grenfell Tower Fire. This questionnaire is concerned with your personal reactions to the traumatic event. Please indicate whether or not you have experienced any of the following AT LEAST TWICE IN THE PAST WEEK:
® C.R. Brewin et al., 2002


Over the last 2 weeks, how often have you been bothered by the following problems?
The PHQ scales were developed by Drs. Robert L. Spitzer, Janet B.W. Williams, and Kurt Kroenke and colleagues. The PHQ scales are free to use. For research information, contact Dr. Kroenke at

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