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Author:
Babu Dubey
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Babu Dubey
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PTSD Template designed by The Guiding Star, NLP Practitioner in Australia
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General symptoms (choose at least three):
*
Negative Self-perception
Nightmare/dreams
Interpersonal Difficulties
Lack of Expressing Feelings
Mood Swings
Avoiding Situations
Physical symptoms (choose at least two):
*
Insomnia
Headache
Gastrointestinal issues
Skin disorder
Rheumatic issues
Are You upset of being at the centre of the incident at least twice in last 7 days? (Choose)
Yes
No
Are you finding difficulty to concentrate at least twice in last 7 days? (Choose)
Yes
No
Unexpected thought comes to mind about that incident against your wish at least twice in last 7 days? (Choose)
Yes
No
Difficulty in falling asleep and staying asleep at least twice in last 7 days? (Choose)
Yes
No
Increased consciousness of potential dangers to You and Your Family at least twice in last 7 days? (Choose)
Yes
No
Are you getting any thought of self-harm at least twice in last 7 days? (Choose)
Yes
No
Personal Details
*
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