Post-Traumatic Stress Disorder Checklist (PCL-5)
Jennifer Daniels PhD, LCPCAccess Counseling Services, Inc.175 Olde Half Day Road, Suite 140-9, Lincolnshire IL 6006919 N. County Street Waukegan IL 60085(224)225-9650 | email@example.com
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 abuse; war; homicide; or suicide.
First, please answer a few questions about 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).
Briefly Identify the worst event (If you feel comfortable doing so):
How long ago did it happen? (estimate is ok)
Did it involve actual or threatened death, serious injury, or sexual violence?
How did you experience it ?
If the event involved death of a close family member or close friend, was it due to some kind of accident or violence, or was it due to natural causes?
Accident or ViolenceNatural Causes
Leave this empty:
Your legal name
Your email address
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Document Name: Post-Traumatic Stress Disorder Checklist (PCL-5)
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