PTSD Evaluations

What do I
need?

A NEW MEXICO DRIVER'S LICENSE
OR ID CARD


This proves New Mexico residency. No other form of identification will be accepted by the department of health.

COMPLETE THE SCREENING FORM BELOW


The form must be completed before your appointment to ensure you meet the screening requirements.

    Which of the following best describes your trauma?
    Witnessing death or injuryPhysical assault/abuseCombat/military experienceMilitary sexual traumaSexual assault/rapeNatural disaster/fireChildhood sexual abuse/molestationAccident: MVA/boating/motorcycleIncarcerationSudden/traumatic death of a family member/friendFirst ResponderChildhood Physical AbuseChildhood Emotional AbuseChildhood Abandonment/NeglectDysfunctional UpbringingLife Threatening ExperienceChildhood Foster CareVictim of Sex TraffickingVictim of Domestic Violence

    Repeated, disturbing, and unwanted memories of the stressful experience?
    Not at allA little bitModeratelyQuite a bitExtremely

    Nightmares or disturbing dreams?
    Not at allA little bitModeratelyQuite a bitExtremely

    Flashbacks?
    Not at allA little bitModeratelyQuite a bitExtremely

    Feeling very upset when something reminded you of the trauma?
    Not at allA little bitModeratelyQuite a bitExtremely

    Anxiety?
    Not at allA little bitModeratelyQuite a bitExtremely

    Avoiding memories of the trauma?
    Not at allA little bitModeratelyQuite a bitExtremely

    Avoiding reminders of the trauma?
    Not at allA little bitModeratelyQuite a bitExtremely

    Trouble remembering parts of the trauma?
    Not at allA little bitModeratelyQuite a bitExtremely

    Negative beliefs about yourself, others, or the world?
    Not at allA little bitModeratelyQuite a bitExtremely

    Blaming yourself or someone else for the trauma?
    Not at allA little bitModeratelyQuite a bitExtremely

    Fear, horror, anger, guilt or shame?
    Not at allA little bitModeratelyQuite a bitExtremely

    Loss of interest in activities you used to enjoy?
    Not at allA little bitModeratelyQuite a bitExtremely

    Feeling detached from others?
    Not at allA little bitModeratelyQuite a bitExtremely

    Trouble experiencing positive emotions?
    Not at allA little bitModeratelyQuite a bitExtremely

    Irritable, angry outbursts, or acting aggressively?
    Not at allA little bitModeratelyQuite a bitExtremely

    Risk-taking?
    Not at allA little bitModeratelyQuite a bitExtremely

    Being super-alert, watchful, or on-guard?
    Not at allA little bitModeratelyQuite a bitExtremely

    Easily startled?
    Not at allA little bitModeratelyQuite a bitExtremely

    Difficulty concentrating?
    Not at allA little bitModeratelyQuite a bitExtremely

    Trouble falling or staying asleep?
    Not at allA little bitModeratelyQuite a bitExtremely

     

    Call Now ButtonCall Us!