PTSD Test

Data Privacy Notice

Please take a moment to answer the following questions. Baron Method respects your privacy rights and aims to comply with the Data Privacy Act (DPA) of 2012, in relation to all Personal Data that we collect from you. When you share your information with us through this form, you also confirm and grant us permission to collect and verify the said information. We will only process your Personal Data for legitimate interest and purpose only in accordance with the Data Privacy Act.

Yes, I agree

Personal Information

First Name

Last Name

Phone

Email Address

In the past month, have you....had nightmares about the event(s) or thought about the event(s) when you did not want to?YesNo

Have you tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)?YesNo

Have you been constantly on guard, watchful, or easily startled?YesNo

Have you felt numb or detached from people, activities, or your surroundings?YesNo

Have you felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused?YesNo