PTSD Symptom Checklist & Assessment Form

Streamline PTSD Assessment with a Professional Symptom Checklist

Post-Traumatic Stress Disorder (PTSD) affects millions of people worldwide, and accurate pre-visit symptom assessment is crucial for effective treatment planning. This PTSD Symptom Checklist & Assessment Form provides mental health professionals, therapists, counselors, and healthcare providers with a structured, compassionate tool to gather critical information before the first appointment.

Why Use This PTSD Assessment Template?

This form template is specifically designed for mental health practices, counseling centers, hospitals, veterans' services, and telehealth providers who need to conduct thorough PTSD screenings. By collecting detailed information about trauma exposure history, flashback frequency, avoidance behaviors, and symptom severity before the appointment, clinicians can:

• Prepare more effectively for patient consultations with comprehensive background information
• Reduce in-session administrative time and focus on therapeutic interventions
• Identify urgent cases that may require immediate attention or crisis intervention
• Track symptom patterns over time for ongoing treatment evaluation
• Ensure patient safety with built-in emergency contact collection

Built for Healthcare Workflows

Created with Paperform's intuitive form builder, this template includes conditional logic that adapts questions based on responses, ensuring patients only see relevant follow-up questions. The professional, calming design creates a safe space for patients to share sensitive information, while the secure data collection ensures HIPAA-aware practices can maintain confidentiality.

The form integrates seamlessly with your existing practice management software, electronic health records (EHR), and scheduling systems. Responses can be automatically routed to Stepper (stepper.io) to trigger follow-up workflows—such as sending appointment confirmations, flagging high-risk cases for immediate review, or updating patient records in your CRM.

Comprehensive PTSD Screening Components

This assessment covers all essential areas for PTSD evaluation:

• Trauma exposure history with sensitivity and respect
• Re-experiencing symptoms including flashback frequency and nightmare patterns
• Avoidance behaviors related to trauma reminders
• Negative mood and cognition changes following the traumatic event
• Hyperarousal symptoms such as hypervigilance and startle response
• Functional impairment assessment across work, relationships, and daily activities
• Current support systems and previous treatment history
• Safety screening for self-harm or suicidal ideation

Whether you're a licensed therapist, psychiatrist, clinical psychologist, or social worker, this template provides a professional, evidence-informed foundation for PTSD assessment that you can customize to match your practice's specific protocols and branding.

Start using this form template today to improve your pre-visit assessment process and provide better care for patients experiencing PTSD symptoms.