Post-Traumatic Stress
Disorder
Assessment
Our Client Intake and Assessment Forms are designed to assist us in knowing more about you, your background, and what specific needs you wish to address. Any information received from these forms will be used for the expressed purpose of assisting you achieve your desired goals and is strictly confidential.
DEMOGRAPHIC ASSESSMENT
5. Explain your depression treatment history
6. Explain your bipolar disorder treatment history
7. Explain your generalized anxiety treatment history
8. Explain your post-traumatic disorder stress treatment history
4. Select your ethnicity/racial group:
3. What is your marital status?
2. What is your gender?
1. What is your age?
1. Have you been bothered by unwanted memories, nightmares, or reminders of this event in the past week?
Post -Traumatic Stress Disorder Assessment
The Post-Traumatic Stress screening questions are presented below. Select one option for each question that comes closest to your answer.
If you have experienced, witnessed or were confronted with an event
that involved actual or threatened death,
abuse or serious injury
in which you felt
intense fear, helplesness,
or horror...
4. Have you been bothered by poor sleep, poor concentration, jumpiness, irritability, or feeling watchful around you in the past week?
2. Have you been making an effort to avoid thinking or talking about this event, or doing things that remind you of what happened in the past week?
3. Have you lost enjoyment for things, kept you distance from people, or found it diffucult to experienced feelings in the past week?
CELEBRATING LIFE RESTORED THROUGH RESILIENCE!
CALL TODAY!
1-877-63RESET
(73738)
© 2010 RESET, LLC All Rights Reserved
