Forensic Psychiatry Intake Form
Intake

Forensic Psychiatry Intake Form

3 pages19 fieldsHIPAA-ready
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Forensic Psychiatry Intake Form
Patient Name
Date of Birth
Referral Source
Select...
Current Legal Charges
Forensic Question to Address
Criminal Justice History
Previous Psychiatric Hospitalizations
Current Medications
Substance Use History
Submit
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This forensic psychiatry intake form is designed specifically for psychiatrists and psychologists conducting evaluations for legal proceedings, criminal courts, and correctional facilities. The template captures unique information required for forensic assessments including referral source, legal charges, competency questions to be addressed, criminal justice involvement history, and previous forensic evaluations. It helps practitioners gather comprehensive background information necessary for competency to stand trial evaluations, insanity defense assessments, risk evaluations, and other medicolegal psychiatric examinations.

The structured workflow includes sections for legal referral details, current charges and court dates, specific forensic questions posed by attorneys or courts, criminal and arrest history, incarceration history, substance abuse in relation to alleged offenses, previous psychiatric hospitalizations, and current mental status observations. The form also captures information about the patient's understanding of legal proceedings and collateral information sources. This template ensures forensic mental health professionals collect all necessary data for comprehensive, legally defensible psychiatric evaluations while maintaining appropriate boundaries between treatment and evaluation roles.

What's included

  • Legal referral information
  • Current criminal charges
  • Court dates and jurisdiction
  • Specific forensic questions
  • Competency evaluation criteria
  • Criminal history timeline
  • Incarceration history
  • Psychiatric hospitalization records
  • Substance abuse history
  • Collateral information sources

Who uses this template

  • Forensic psychiatry practices
  • Court evaluation services
  • Correctional facility mental health
  • Expert witness psychiatrists
  • Criminal defense attorneys

All form fields

9 fields across 3 pages. Customize any field after signing up.

Patient NameText
Date of BirthDate
Referral SourceDropdown
Current Legal ChargesLong Text
Forensic Question to AddressLong Text
Criminal Justice HistoryLong Text
Previous Psychiatric HospitalizationsLong Text
Current MedicationsMedications
Substance Use HistoryLong Text
8 min saved per patient98% patient satisfaction3x faster than paper

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