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View this mental health intake form and click on "use template" after making sure this is what you are looking for.
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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.
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:
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