Forensic Symptom Validity Assessment Form
Use this form to document a forensic symptom validity evaluation, including referral details, symptom history, records reviewed, behavioral observations, validity concerns, and conclusions.
Examinee and Case Details
Examinee full name
*
First Name
Middle Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Age
Referral source
*
Evaluator/examiner name
*
Evaluation date
*
-
Month
-
Day
Year
Date
Case/reference number
Referral Reason and Evaluation Scope
Reason for Referral
*
Evaluation Setting
*
Clinical
Forensic
Correctional
Disability
Other
Alleged Symptom Domains to Assess
*
Memory
Pain
Cognition
Mood
Psychosis
Physical Functioning
Other
Specific Questions to Be Answered
*
Symptom History and Timeline
Symptom onset date
-
Month
-
Day
Year
Date
Approximate symptom onset
Duration of symptoms
Days
Weeks
Months
Years
Unknown
Change over time
*
Improved
Worsened
Unchanged
Fluctuating
Known triggers or contextual events
Prior related diagnoses or episodes
If symptoms have worsened or are fluctuating, describe the pattern and any notable changes
Medical, Psychiatric, and Treatment Background
Medical history
Psychiatric history
Current medications and dosages
Prior counseling or therapy
*
Yes
No
Details of prior counseling or therapy
Prior hospitalizations or crisis episodes
*
Yes
No
Details of prior hospitalizations or crisis episodes
Prior Testing and Records Review
Any prior psychological, neuropsychological, or forensic testing?
*
Yes
No
Names and dates of prior assessments
Availability of records
*
Please Select
Provided
Pending
Unavailable
Key record sources reviewed
Medical records
Therapy notes
Prior reports
Collateral statements
Other
Behavioral Observation and Performance Validity
Cooperation Level
*
Very Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Very Poor, 10 is Excellent
Attentiveness
*
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
Effort / Persistence
*
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
Response Consistency Across Tasks
*
Rows
Consistent
Somewhat Consistent
Inconsistent
Orientation/Attention Tasks
1
2
3
Memory Tasks
4
5
6
Symptom Inquiry
7
8
9
Performance Tasks
10
11
12
Observed Behavior During Interview / Testing
*
Apparent Distress or Fatigue
*
None observed
Mild
Moderate
Marked
Other
Details of Distress or Fatigue
Validity Indicators or Performance Concerns
Symptom Credibility and Consistency Review
Internal consistency of reported symptoms
*
Consistent
Mostly consistent
Mixed
Mostly inconsistent
Inconsistent
Consistency with collateral information and records
*
Consistent
Mostly consistent
Mixed
Mostly inconsistent
Inconsistent
Not available
Plausibility of symptom presentation
*
Not plausible
1
2
3
4
5
6
7
8
9
Highly plausible
10
1 is Not plausible, 10 is Highly plausible
Examples of inconsistencies or discrepancies noted
Examiner concern about exaggerated, inconsistent, or non-credible responding
*
None
Minimal
Mild
Moderate
High
Overall credibility impression
*
1
2
3
4
5
Contextual and External Factors
Factors Affecting Performance
Sleep problems
Pain or physical discomfort
High stress or emotional distress
Substance use concerns
Language or communication barriers
Sensory limitations
Motor limitations
Motivation or incentive concerns
Environmental distractions
Other
Sleep Quality
Good
Fair
Poor
Very poor
Pain or Physical Discomfort
None
Mild
Moderate
Severe
Stress Level
Low
Moderate
High
Very high
Substance Use Concerns
None reported
Possible recent use
Current concern
Unclear
Additional Context or Explanation
Examiner Conclusions and Recommendations
Overall Opinion
*
Summary of Findings
*
Recommended Next Steps
*
Recommendation Priority
High
Moderate
Low
Submit Assessment
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