PTSD Forms, Assessments and Guides

PTSD Assessment Form

This form is a Post Traumatic Stress Disorder (PTSD) Assessment (printable only), and by no means constitutes a diagnosis of PostTraumatic Stress Disorder; nor is accurate for self diagnosis or self assessment of PTSD. This form acts as a guide only in which you may take to your counsellor / physician for discussion, or use on a continuous basis to mark your own personal achievements in PTSD recovery.

How To Use The PTSD Assessment

Simply read the questions (consisting 125 off), select the most appropriate answer that relates to your current state of mind or physical ailment, then preview the assessment for printing. Your first answer is often your correct answer. Don't over think or reread once answered.

We recommend that you only fill out this form for self appraisal and documentation once per quarter, or else you will find yourself over analysing and creating a new stream of concerns for yourself.

The information within this form IS documented for statistical purposes, however; NO personal identification is stored, including IP or location. There are no names, email or personally identifiable information required, or saved from using this form. It is confidential and processes securely.

Part 1 - Your Life

To what extent do you feel that physical pain prevents you doing what you need to?

Not at All Small Amount Moderate Amount Great Deal Extreme Amount

How satisfied are you with your ability to perform your daily living activities?

Very Dissatisfied Dissatisfied Neither Satisfied Very Satisfied

Part 2 - Your Use of Health Services

Have you been admitted to hospital in the past 6 months and stayed atleast one night?

Yes No

Have you ever participated in better health programs? (lifestyle, anger management, etc)

Yes No

Part 3 - Relationships

Do you have a spouse?

Yes No (Skip this section and move to Part 4)

Indicate the approximate extent of agreement / disagreement between you and your spouse for the following:

How often would you say the following events occur between you and your partner:

The choice below represents the degree of happiness in your relationship:

Part 4 - Stress and Trauma

Suddenly acting or feeling as if a stressful experience were happening again, as if you were reliving it?

Not at All Little Bit Moderately Quite a Bit Extremely

Having physical reactions, (eg. heart pounding, breathing, etc) when something reminded you of a stressful experience?

Not at All Little Bit Moderately Quite a Bit Extremely

Avoiding thinking or talking about a stressful experience, or avoiding having feelings related too it?

Not at All Little Bit Moderately Quite a Bit Extremely

Part 5 - Feelings

I feel tense or wound up?

Most of the Time A Lot of the Time Occasionally Not at All

I feel as if I am slowed down?

Nearly all the Time Very Often Sometimes Not at All

I still enjoy the things I used to enjoy?

Definitely as Much Not Quite so Much Only a Little Hardly at All

I get a sort of frightened feeling as if something awful is about to happen?

Not at All Occasionally Quite Often Very Often

I have lost interest in my appearance?

Definitely I Don't Take as Much Care as I Should May Not Take as Much Care As Much as Ever Before

I can laugh and see the funny side of things?

Always Sometimes Little of the Time Not at All

I feel restless, as if I have to be on the move?

Very Much Quite a Lot Not Very Much Not at All

Worrying thoughts go through my mind?

Great Deal of The Time Lot of The Time From Time to Time Not Often

I look forward with enjoyment to things?

As Much as Ever Less Than I Used Too Definitely Less Than Used Too Hardly at All

I feel cheerful?

Not at All Not Often Sometimes Most of the Time

I get sudden feelings of panic?

Very Often Quite Often Not Very Often Not at All

I can sit at ease and feel relaxed?

Definitely Usually Not Often Not at All

I can still enjoy a book, radio or television program?

Often Sometimes Not Often Very Seldom