Free From Trauma: PCL-5 Form

The PCL-5 form assesses for symptoms of possible post-traumatic stress disorder (PTSD).

I ask my clients to fill in this form before and after a session of Multichannel Eye Movement Integration (MEMI) to assess whether MEMI is appropriate and effective for the client. 

The information that you submit in this form is encrypted such that only you and I can view it. It will be kept confidential and used only for the purposes of your therapy sessions with me.

More information about the PCL-5 can be found here.

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 check the box that that indicates how much you have been bothered by that problem in the past month.

In the past month, how much were you bothered by:

Please click "Submit" to send the information in this form to Eunice Tan at Free From Trauma.