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PTSD and Anxiety Questionnaire

AT A GLANCE

PHI’s PTSD and anxiety questionnaire is a free self-check you complete on this page. It pairs two standard screening checklists, the PTSD Checklist (PCL-C) and the GAD-7 for anxiety, and shows your scores as soon as you finish. Your answers stay on your device. Bring your results to a consultation with our physicians in Beverly Hills, who treat PTSD and anxiety with stellate ganglion block (SGB) and ketamine infusion therapy.

Take the Questionnaire

Choose one answer for each question in Parts 1 and 2, then select See my results. Part 3 is optional. The PTSD checklist takes about 5 to 10 minutes. [1]

Your answers stay on this device. Nothing you choose is sent to PHI or anyone else, and nothing is saved. To keep a copy for your consultation, print it or save it as a PDF.

Part 1: PTSD checklist

Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Read each one carefully, then choose how much you have been bothered by that problem in the past month.

1. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?
2. Repeated, disturbing dreams of a stressful experience from the past?
3. Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it)?
4. Feeling very upset when something reminded you of a stressful experience from the past?
5. Having physical reactions (for example, heart pounding, trouble breathing, sweating) when something reminded you of a stressful experience from the past?
6. Avoiding thinking about or talking about a stressful experience from the past or avoiding having feelings related to it?
7. Avoiding activities or situations because they reminded you of a stressful experience from the past?
8. Trouble remembering important parts of a stressful experience from the past?
9. Loss of interest in activities that you used to enjoy?
10. Feeling distant or cut off from other people?
11. Feeling emotionally numb or being unable to have loving feelings for those close to you?
12. Feeling as if your future will somehow be cut short?
13. Trouble falling or staying asleep?
14. Feeling irritable or having angry outbursts?
15. Having difficulty concentrating?
16. Being "super-alert" or watchful or on guard?
17. Feeling jumpy or easily startled?

Part 2: Anxiety checklist

Over the last 2 weeks, how often have you been bothered by the following problems?

1. Feeling nervous, anxious, or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid, as if something awful might happen
If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?

Part 3: For your consultation (optional)

These answers are not scored. They print with your results so you can bring them to your visit.

Have you had a traumatic experience?
Do you have a mental health diagnosis?
If yes, are you currently under the care of a behavioral health professional or physician?
Are you currently taking any medication?

What Your Scores Mean

The PTSD checklist adds up 17 answers, each scored from 1 to 5, for a total between 17 and 85. Higher scores mean more PTSD symptoms over the past month. For pain clinics and other specialty medical practices, the suggested screening cut-point falls between 36 and 44. [1]

The anxiety checklist adds up seven answers, each scored from 0 to 3, for a total between 0 and 21. Scores of 5, 10 and 15 mark mild, moderate and severe anxiety, and a score of 10 or more is the point where a clinician should take a closer look. [2]

A physician makes the diagnosis at your consultation. Your scores show how much these symptoms are affecting you and give that conversation a starting point.

Treatment for PTSD and Anxiety at PHI

PHI’s physicians treat PTSD and anxiety with two fast-acting options. A stellate ganglion block (SGB) is an image-guided injection that calms the body’s fight-or-flight response, and many patients feel relief within 30 minutes. Ketamine infusion therapy works on the brain pathways behind depression, anxiety and intrusive thoughts. Some patients benefit from both, and we plan the order at consultation.

Veterans receive a discount on stellate ganglion block for PTSD. Let us know you served when you reach out.

Read more about how we approach PTSD and anxiety.

Questions About the Questionnaire

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A 60-minute consultation includes history, imaging review, and an honest discussion of whether interventional or regenerative care is the right next step for you.

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