Behavioral Health Intake Form

The Behavioral Health Intake Form is designed for community behavioral health organizations, capturing the comprehensive biopsychosocial assessment data that clinicians need for treatment planning across a wide range of mental health and substance use conditions. This template collects patient demographics alongside a detailed presenting concern assessment, behavioral health symptom screening (depression, anxiety, PTSD, psychosis, mania, ADHD), substance use history (type, frequency, quantity, route, age of first use, longest period of sobriety), withdrawal risk assessment, and trauma exposure screening using a structured, trauma-informed approach.

Built for community mental health centers, outpatient behavioral health agencies, substance abuse treatment programs, and integrated behavioral health practices, this form includes sections for psychosocial history (family of origin, relationships, children, housing stability, employment, education, legal involvement, military service), prior behavioral health treatment (therapy, medication management, intensive outpatient, partial hospitalization, residential treatment, detox), current medications and prescribers, physical health conditions that affect behavioral health treatment, cultural and spiritual considerations, and treatment readiness assessment. The strengths and resources section identifies protective factors and natural supports that inform strengths-based treatment planning.

All fields are HIPAA-compliant and designed with trauma-informed principles. The form uses clear, non-stigmatizing language and allows patients to share information at their comfort level with optional fields for sensitive topics. The comprehensive format supports compliance with state licensing requirements and accreditation standards (CARF, Joint Commission) that mandate thorough biopsychosocial assessment at intake. Pre-visit completion reduces clinical burden and allows the initial session to focus on building rapport and collaborative treatment planning.