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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.

Mental Health Intake Form


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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There are no limits and boundaries when it comes to creating online forms, surveys, and exams with! You can choose one of many types of templates, create a form, and get started right away! Once you start with a template, you can easily customize your form fields, form design, and many other attributes!

You can share your forms in any way you like. If you want to share your form and collect responses through your form’s unique link, you can simply adjust privacy settings and copy-paste your form link anywhere. And if you would like to embed your form in your website, you can easily copy and paste embed code in your website HTML.

On, you can customize your form’s theme and design elements in depth. Once you switch to the ‘Design’ tab after getting your form done, you will see many different design customization options. You can change your form theme by choosing your own colors or picking one of many ready-made themes.