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VAC PEN 6248: Psychiatric/Psychological Questionnaire

Veterans Affairs Canada uses this eight-page questionnaire, part of its medical questionnaires that complement the Table of Disabilities, to document confirmed DSM diagnoses, such as PTSD, and assess their severity for disability benefits. The clinician rates memory, perception, mood, anxiety, trauma, sleep, substance use, coping and daily living, often on frequency scales, and details treatment and hospital care.

Who completes it

Psychiatrists, registered, licensed or associate psychologists, general practitioners, nurse practitioners and physician assistants in listed provinces can complete it; candidate psychologists only with a co-signature, and psychotherapists and clinical or professional counsellors for assessment only. Social workers are not accepted.

Submitting and payment

How to submit it
VAC tells clients not to have a medical questionnaire completed until it gives specific instructions about which one is required, and the completed form is returned as VAC instructs.
Who pays
The form asks whether VAC is to be invoiced for its completion.

Good to know

  • List psychiatric diagnoses, personality disorders and pertinent medical conditions separately, and describe the psychiatric history with date of onset and contributing or precipitating factors.
  • Symptoms such as delusions, hallucinations and panic attacks are rated by frequency, from at least once a year to daily or almost daily; memory findings can cite a MoCA or MMSE.
  • Treatment questions cover peer support such as AA or OSISS, visit frequency, medications, three or more medication changes in a year, inpatient care in the last 2 years and medical cannabis.
  • Coping is rated on a seven-statement scale, from adequate coping to marked regression or psychotic symptoms lasting more than 24 hours in response to stress.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Questionnaire: Psychiatric/Psychological Condition(s)

Questionnaire médical : Affections psychologiques/psychiatriques

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Can a social worker complete VAC's psychiatric questionnaire?

No. VAC's page on who can complete its medical questionnaires states that social workers are not accepted for PEN 6248. Candidate registered psychologists are accepted only if a registered, licensed or associate psychologist or a psychiatrist co-signs, and psychotherapists and clinical or professional counsellors may complete it for assessment or reassessment only.

What does PEN 6248 ask about sleep and substance use?

The sleep section asks about insomnia, whether it occurs on most nights and whether sleep loss is more or less than 120 minutes. The substance use section, which includes addictive disorders such as gambling disorder, asks for each substance or disorder, whether it is current or in remission, and its severity: mild, moderate or severe.

Is PEN 6248 available in French?

Yes. VAC publishes it in English as PEN 6248e and in French as Questionnaire médical : Affections psychologiques/psychiatriques. The form was first issued in March 2015, the current PDF is dated 2024-05, and it runs eight pages including space for additional information.