CLIENT TRAUMA
SCREENING FORM

upsetting thoughts that have come into your mind

yes

no

upsetting dreams

yes

no

feeling as though the event was happening again

yes

no

feeling upset by the reminders of the event

yes

no

bodily reactions (beatingheart, nausea, etc.)

yes

no

difficulty falling or staying asleep

yes

no

sudden outbursts of anger or sadness

yes

no

difficulty concentrating on anything else

yes

no

heightened awareness of danger

yes

no

heightened sense of jumpiness or startle

yes

no