PTSD Questionnaire
If you think you might suffer from PTSD, but do not have a diagnosis by a physician we can help.
For an additional $99 one of our licensed physicians can evaluate you for PTSD in a separate Tele-health visit (both are usually on the same day). Fill out the questionnaire below and we will reach out once it is received.
The PCL-5 is a psychometrically sound measure of PTSD as defined by the DSM-V (Diagnostic and Statistical Manual of Mental Disorders)
The PCL-5 has been validated in several studies and is a reliable tool in quantifying PTSD symptoms as well as severity.
It offers a provisional diagnosis of PTSD based on 20 questions which ask severity of each PTSD symptom you might have experienced recently
We recommend further testing be done with your physician for a comprehensive diagnosis.
Note: This is a fillable form. You may complete it electronically.
Instructions
This questionnaire asks about problems you may have had after a very stressful experience involving actual or threatened death, serious injury, or sexual violence. It could be
something that happened to you directly, something you witnessed, or something you learned happened to a close family member or close friend. Some examples are a serious accident; fire; disaster such as a hurricane, tornado, or earthquake; physical or sexual attack or abuse; war; homicide; or suicide.
When filling this checklist out, think of your worst event, which for this questionnaire
means the event that currently bothers you the most. This could be one of the examples above or some other very stressful experience. Also, it could be a single event (for example, a car crash) or multiple similar events (for example, multiple stressful events in a war-zone or repeated sexual abuse).
PCL-5
Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem and then select one of the options to indicate how much you have been bothered by that problem in the past week. The options include not at all, a little bit, moderately, quite a bit, and extremely.