OBJECTIVES: Patient reported outcomes (PROs) are variously used across drug development and post-marketing.  In this way, outcomes researchers are often tasked with developing PRO questionnaires to suit these multiple contexts. The purpose of this research is to provide suggestions and an example of how outcomes researchers might approach simultaneous development of a PRO questionnaire for use in two unique contexts - clinical trials to evaluate efficacy claims and in clinical settings to facilitate patient-provider discussions. METHODS: In the context of developing and modifying sign- and symptom-focused tools for patients with chronic plaque psoriasis, questionnaire development was informed by a) literature review, expert advice meetings (n=3), patient concept elicitation interviews (N=60), b) concept selection and questionnaire construction activities, c) content evaluation (N=20), and d) and psychometric evaluation (N=200).  Given the multiple contexts of use intended for the questionnaire, instrument developers created distinct, albeit corresponding questionnaires paying close attention to content, response options, recall period, focus of measurement (e.g., symptom at its worst vs. symptom on average), and number of items.  RESULTS: Developers simultaneously created and modified two questionnaires. The Self-Assessment of Psoriasis Symptoms for Clinical Trials (SAPS-CT) has nine items and asks respondents to rate their symptom “at its worst” in the 24 hours prior to assessment while the SAPS for Real World (SAPS-RW) has six items and asks respondents to rate their symptoms “on average” in the seven days prior to assessment.  Results support both tools as content valid and capable of generating reliable and valid scores when administered among patients with chronic plaque psoriasis. CONCLUSIONS: Though not without challenges and limitations, the methods and results presented here may provide a model for outcomes researchers to more efficiently develop unique versions of a questionnaire suitable to the multiple contexts for which they are often asked to create PRO questionnaires.