PCL 5 FORM

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Home
Start Maine Certification
- Telemedicine Certification Form
- In-Person
Start Florida Certification
Pricing
About
- Blog
- FAQs
- Reviews
Contact Us
- Locations
  - ME Office
  - FL Offices

MAINE CERTIFICATION

(207) 241-2815

Text: (207) 241-2815

Telemedicine Available

Book Now ( Maine Only)

FLORIDA CERTIFICATION

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Telemedicine Available

Online Booking Coming Soon

Text: SUMMER to (207) 241-2815 to get Certified!!!

PCL 5 FORM

PCL 5 FORM

State Florida Certification - PCL 5 FORM

Name:

Free Text

PCL-5

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

Please answer the questions based on your past month and NOT medicated.

Please select answer to "How much were you bothered by" : 0 not at all - 4 Extremely

1. Repeated, disturbing, and unwanted memories of the stressful experience?

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2. Repeated, disturbing dreams of the stressful experience?

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3. Feeling very upset when something reminded you of the stressful experience

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4. Avoiding memories, thoughts, or feelings related to stressful experience?

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5. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects or situations?)

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6. Trouble remembering important parts of the stressful experience

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7. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous?)

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8. Blaming yourself or someone else for the stressful experience or what happened after it?

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9. Having strong negative feelings such as fear, horror, anger, guilt or shame.

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10. Feeling distant or cut off from other people?

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11. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?

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12. Irritable behavior, angry outbursts, or acting aggressively?

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13. Taking too many risks or doing things that could cause you harm?

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14.Having difficulty concentrating?

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15. Trouble falling or staying asleep?

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Thank you for contacting us.
We will get back to you as soon as possible.

Oops, there was an error sending your message.
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All Patients with Anxiety, Depression, PTSD or any other Mental Health problems have to fill out the form.

SUMMERFIELD, FL LOCATION

,

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Fax: (352) 787-0682

Location Details

GAINESVILLE, FL LOCATION

Call for Information!

Fax: (352) 787-0682

Location Details

AUBURN, ME LOCATION

Relief Clinic LLC

216 Center Street

Auburn, ME 04210

(207) 241-2815

Location Details

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