Psychology/Post Trauma Stress Assessment

= Post-Traumatic Stress Assessment = Date: ___________________

Client Name:_____________________

Trauma: ________________________ Date of 1st Instance: ____________________________

Since the trauma, which of the following is being experienced, and how frequently?

Presently taking medication? Yes: _______ No: _________Explain: _________________________________________________________

Specific Health Problems:

Explain: __________________________________________________________

Doctor: __________________________________________________________