This questionnaire is for the purpose of getting to know you better in order to provide the best possible mental health services. Please complete this form as honestly and completely as possible.

How would you prioritize the issues that you would like to work on? How do you see the situation? If you have symptoms how would you describe them and when did they first appear? What are stressors in your life currently? What do you think is important to know about you? 2. Mental and Physical Health History.

Sep 18, 2008 · Clinical Interview Form: Please complete this form prior to your appointment. Although it is lengthy, it is important to obtain a clear and accurate developmental history of each client in order to understand his or her learning ability and behavior. It will also help us in formulating a remediation plan for him or her.

The Mental Health Intake & Evaluation Forms describe background information, basic medical history and current functioning (such as mood and thought processes) needed for the intake process. Documents are in Microsoft Word (.docx) format.

While you will be interviewed by a mental health specialist, answering these questions will help us to: • Better assess your current needs. • Understand the reasons you’ve chosen to seek mental health care. • Recommend different types of treatments to assist in your recovery.

Do you currently take medications or supplements to treat mental/emotional difficulties or substance. If yes, please complete the following chart. (Later in the questionnaire, you will be asked to list

INTAKE INTERVIEW FORM (page 2) D. Family Mental Health History: Anyone have history of drug abuse? ... Mental illness, emotional disorders (depression, anxiety, schizophrenia)? Who? Learning disabilities (mental retardation, literacy deficits, hyperactivity) ? Who? ... INTAKE INTERVIEW FORM (page 3) III. Medical/Health History Are you under a ...

Following are questions regarding your personal history. The purpose of this form is to gather initial background information in order to save time in your first session. Please feel free to skip questions that do not apply to your particular situation or that you are not comfortable answering.

Please list all mental health treatment, substance abuse treatment or hospitalizations Facility/Therapist Purpose Current Past Response to Treatment: …

Sep 15, 2024 · If you’re looking for free mental health assessment forms to help you in your mental health practice, don’t miss our comprehensive mental health intake form PDF that can be used by therapists, counselors, psychologists, psychiatrists, and other health professionals.