Each of the following statements has a scale beneath it. The numbers correspond to the following frequency and severity. Please circle the numbers that best represent your current feelings and general frequency.
For frequency : 
1 = Never
1 = Never2 = Occasionally3 = More then once a month4 = Several times a week5 = At least once per dayFor level of symptoms: 1 = None
2 = Mild3 = Moderate4 = Severe5 = Very severe1. Difficulty with sleep.
Frequency
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12345
2345Level
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12345
23452. Intrusive thoughts about a trauma/something bad happening.
Frequency
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12345
2345Level
______________________________________________
12345
2345Copyright The Thorndon Clinic 2009
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Thorndon Post-Traumatic Stress Disorder (PTSD) Explorer
