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PCL-5 PTSD Screening Checklist

Asks about date of screening, repeated disturbing memories, and repeated disturbing dreams. Built for behavioral health clinics screening for PTSD in trauma-exposed patients.

Questions
22
Pages
3
Time
about 6 min
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Your practice

PCL-5 PTSD Screening Checklist

Page 1 of 3 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Behavioral health clinics screening for PTSD in trauma-exposed patients
  • VA and military health facilities conducting routine PTSD assessments
  • Primary care practices screening first responders and at-risk populations
  • Treatment outcome monitoring for trauma-focused therapy programs

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What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of ScreeningDate
  3. Repeated disturbing memoriesLong Text
  4. Repeated disturbing dreamsLong Text

Page 2 · Additional details

  1. Avoiding external remindersLong Text
  2. Trouble remembering important parts of the eventLong Text
  3. Strong negative beliefs about self or worldLong Text
  4. Blaming self or others for the eventLong Text

Page 3 · Additional details

  1. Irritable or angry behaviorLong Text
  2. Taking too many risks or self-destructive behaviorLong Text
  3. Being super alert or on guardLong Text
  4. Feeling jumpy or easily startledLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the PCL-5 PTSD Screening Checklist, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 22 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The PCL-5 PTSD Screening Checklist works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the PCL-5 PTSD Screening Checklist to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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