Dissociative Symptoms Worksheet

Severity of Dissociative Symptoms - Adult

  • Date Format: MM slash DD slash YYYY
  • Input a value that best fits you. (0) Not at all, (1) Once or twice, (2) Almost every day, (3) About once a day, (4) More than once a day
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
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