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PTSD Checklist (PCL-5) Screening

Asks about date of screening, brief trauma description, and repeated, disturbing memories. Built for behavioral health and trauma therapy intake and monitoring.

Questions
14
Pages
2
Time
about 4 min
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PTSD Checklist (PCL-5) Screening

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Behavioral health and trauma therapy intake and monitoring
  • Veterans Affairs and military health PTSD screening
  • Primary care trauma-informed screening programs
  • First responder and employee assistance program assessments

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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. Brief Trauma DescriptionLong Text
  4. Repeated, disturbing memoriesLong Text
  5. Repeated, disturbing dreamsLong Text

Page 2 · Additional details

  1. Avoiding external remindersLong Text
  2. Negative beliefs about yourself or the worldLong Text
  3. Loss of interest in activitiesLong Text
  4. Feeling irritable or angryLong Text
  5. Difficulty concentratingLong 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 PTSD Checklist (PCL-5) Screening, 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 14 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 PTSD Checklist (PCL-5) Screening 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 PTSD Checklist (PCL-5) Screening to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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