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YOUR CART
Do you believe you may suffer from Post-Traumatic Stress Disorder (PTSD)?
Take this brief survey and we can discuss during our phone consultation.
Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past month.
In the past month, how much were you bothered by:
*
Indicates required field
1. Repeated, disturbing, and unwanted memories of the stressful experience?
*
Not at all
A little bit
Moderately
Quite a bit
Extremely
Select one.
2. Repeated, disturbing dreams of the stressful experience?
*
Not at all
A little bit
Moderately
Quite a bit
Extremely
Select one.
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
*
Not at all
A little bit
Moderately
Quite a bit
Extremely
Select one.
Select One
*
Option 1
Option 2
Option 3
Select One
*
Option 1
Option 2
Option 3
Submit