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Trauma Symptom Survey

In order for us to assess your level of risk we ask you to take a couple of minutes to complete a Trauma Symptom Survey.  Please note that any information you provide is completely confidential and will only be used for the purpose of assessing your risk and to get in contact with you. 

Contact Details
Preferred Communication Method

Have you engaged in therapy in the last 20 months? If so, how many sessions or what time frame approximately?

Have you found this therapy effective?

1. I have trouble focusing on conversations, watching TV or reading.
2. Memories of the event/s return at unwanted times.
3. Parts of the event are hard to remember.
4. I avoid certain places, people or events that remind me of the trauma.
5. I feel waves of, guilt, anger and irritability often.
6. I feel on edge.
7. Memories of the traumatic event are so vivid they feel like they are re-occurring.
8. I feel disconnected from friends and family and those close to me.
9. I struggle getting to sleep and staying asleep.
10. I feel frozen, stuck or immobilised.

Thank you for submitting your survey we'll be in touch shortly.

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