DSM-5 Level 1 Cross-Cutting Symptom Measure Assessment Form

Use this self-rated measure to screen key mental health domains relevant to a psychiatric evaluation.

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Initials Only (No Full Name)

Date

The following questions describe things that may have bothered you. For each one, indicate how much (or how often) it has bothered you during the past TWO (2) WEEKS.

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DSM-5 Level 1 Cross-Cutting Symptom Measure Assessment Form

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