Assessment Request Form

To request any of the listed National Center for PTSD assessment instruments, complete and submit this form online, OR print the completed form and mail to the address listed at the bottom of the page.

PLEASE NOTE: Access to these professional instruments is somewhat limited. The American Psychological Association's ethical guidelines on psychological test instruments require advanced graduate level training in the administration and interpretation of psychodiagnostic assessment instruments. Thus, typically we are not able to distribute the measure to people who do not hold at least a master's degree in a clinical discipline. Access to these measures requires proof of clinical status or research credentials. Please also clarify your intended use of the measure. Students who want measures for course papers are encouraged to use sample items or have their clinical professors make the formal request.

The following scales are now available online in PDF format:

• Traumatic Events Screening Inventory for Children (TESI-C)
• Combat Exposure Scale (CES)
• Primary Care PTSD Screen (PC-PTSD)
• Life Events Checklist (LEC)

By checking this box you certify that you have advanced graduate level training in the administration and interpretation of psychodiagnostic assessment instruments; hold at least a master's degree in a clinical discipline; or possess research credentials.

Fields marked with * are required. Allow 7-10 days for processing.

ONLY the scales listed above can be requested with this form. For other assessment instruments see information on the individual measure you are interested in.

I prefer to be contacted by: E-mail Phone

*Information on this form is collected for acknowledgement and verification of credentials only.

or

If you prefer to make your request by mail-

Print this form and mail to:

Assessment Requests
National Center for PTSD (116D)
VA Medical Center
215 N. Main St.
White River Junction, VT 05009

Do NOT try to diagnose yourself for PTSD. Please contact your doctor or a mental health specialist. You can get more information about how to get help in the following Fact Sheets:

• Specialized PTSD Treatment Programs in the U.S. Department of Veterans Affairs
• Finding and Choosing a Therapist
• You may also want to visit the Where to Get Help page for additional resources.

PLEASE NOTE: The National Center for PTSD will not provide assessment tools to untrained professionals. If you have any questions please contact ncptsd.assessment@va.gov.