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Mental Health Intake Form

The mental health intake form is a document that captures the details of an individual's experience with their mental health. By using an online form, you can gather the necessary information in a standardized way before consulting with the patient. This mental health intake form template was created to help clinicians streamline the data collecting process and worm more efficiently.

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Mental Health Intake Form

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What is a mental health intake form?

A mental health intake form is a document used by mental health professionals to gather information about a patient's mental health history. The form includes questions about the patient's symptoms, psychiatric history, and family history of mental illness.

If the patient has the ability to make decisions for his/her life, these inquiry forms should be filled out by the patient. Otherwise, the mental health intake form should be completed by someone who has had contact with a person in crisis and can provide information about their relevant history, current symptoms, and risk factors for suicide or self-harm.

Some details you can gather with a mental health intake form

When creating the mental health intake form, it is important to ask for as much information as possible. The following are some key points to consider:

  • The individual's name and contact information
  • The date and location of the incident/emergency
  • The nature of the crisis (e.g., thoughts of suicide, self-harm, psychosis, etc.)
  • The individual's current mental state
  • Any previous mental health treatments or hospitalizations
  • The individual's family history of mental illness
  • Any recent major life changes or stressors
  • The individual's current medications and dosages
  • Any other relevant information

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