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.

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