PTSD Checklist PCL-5 Self-Report Screening Form
PTSD Checklist PCL-5 Self-Report Screening Form
DSM-5 aligned 20-item self-report screener rating the severity of PTSD symptoms over the past month.
Below is a list of problems people sometimes have in response to a stressful experience. Rate how much each bothered you in the past month.
Patient name *
Your answer
Date of birth
Brief description of worst traumatic event (optional)
Your answer
Repeated, disturbing memories of the experience
Repeated, disturbing dreams about the experience
Suddenly feeling or acting as if it were happening again
Feeling very upset when something reminded you
+ 17 more questions
About this template
DSM-5 aligned 20-item self-report screener rating the severity of PTSD symptoms over the past month.
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