1. Have you experienced or witnessed a life-threatening event that caused helplessness, fear, or horror?

No   Yes

2. Do you have recurrent distressing dreams or memories?

No Yes

3. Do you have difficulty falling or staying asleep out of fear or anxiety?

No Yes

4. Do you experience distressed recollections of the event including images, thoughts or perceptions?

No Yes

5. Do you experience bodily reactions, which resemble an aspect of a specific traumatic event? ( Ex: Sight, sense, smells)

No Yes

6. Do you have trouble concentrating or recalling events?

No Yes

7. Do you overreact to certain situations or people easily?

No Yes

8. Do you avoid certain types of places that remind you of your past?

No Yes

9. Do you have trouble connecting with people?

No Yes

10. Do you tend to avoid conflict in your life?

No Yes

11. Do you get startled easily?

No Yes

12. On more days than not, do you experience feelings of sadness or guilt?

No Yes

13. Have you experienced changes in your eating habits? Either increase or decrease in appetite?

No Yes

14. Have you recently experienced chronic fatigue, headaches or tension that have lasted longer than a few days or weeks?

No Yes

15. Is it difficult for you to imagine your future, such as career, marriage, children, or a normal life span?

No Yes

16. Are you losing interest in normal daily activities in your life?

No Yes

17. Do you find yourself increasing your alcohol or drug use during social situations?

No Yes

18. Are you experiencing big gaps in memory when you think about your childhood?

No Yes

19. DISCLAIMER

This Site Does Not Provide Medical Advice.

The contents of the Brookhaven Retreat, LLC (“Brookhaven”) website ( the "Content") are for informational purposes only. The Content is not intended to be a substitute for professional psychological psychiatric or medical advice, diagnosis, or treatment. Consult with your physician, psychiatrist, psychologist, or other qualified health provider without delay to gain more information regarding your specific medical and/or psychological condition.

If you think you may have a medical emergency, call your doctor or 911 immediately. Brookhaven does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Brookhaven, Brookhaven employees, others appearing on the Site at the invitation of Brookhaven, or other visitors to the Site is solely at your own risk.

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