PTSD Symptom Assessment Form
Name
Assessment Date
Clinician
Symptom Assessment
Re-experiencing traumatic events
None
Mild
Moderate
Severe
Avoidance of reminders
None
Mild
Moderate
Severe
Negative thoughts and mood
None
Mild
Moderate
Severe
Hyperarousal (e.g., irritability, alertness)
None
Mild
Moderate
Severe
Duration of Symptoms
Impact on Daily Life
Additional Notes