Mental Health Intake Form
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Mental Health Intake Form
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The Mental Health Intake Form is purpose-built for therapists, counselors, psychiatrists, and behavioral health practices. It goes beyond standard demographics to capture the clinical information mental health providers need before a first session: presenting concerns, mood and anxiety screening questions modeled on PHQ-9 and GAD-7, previous treatment history, current psychiatric medications, and substance use screening.
This template includes a dedicated safety assessment section that screens for suicidal ideation, self-harm history, and access to means -- critical information that helps providers prepare for the first encounter. The treatment goals section helps patients articulate what they hope to achieve in therapy, setting the foundation for collaborative treatment planning.
The form is structured with sensitivity in mind. Instructions use warm, non-clinical language. Optional fields allow patients to share at their comfort level. The multi-page format prevents patients from feeling overwhelmed by the depth of information requested. All responses are encrypted and stored with HIPAA-grade security.
What's included
- PHQ-9 and GAD-7 style mood screening
- Substance use and safety assessment
- Medication list with dosage and frequency tracking
- Therapy goals and expectations
- Emergency contact information
- Consent agreement with e-signature
Who uses this template
- Therapists and licensed counselors
- Psychiatry and behavioral health practices
- Community mental health centers
- Employee assistance programs (EAP)
All form fields
13 fields across 3 pages. Customize any field after signing up.
How to use the Mental Health Intake Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Mental Health Intake Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Mental Health Intake Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 13 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Mental Health Intake Form HIPAA compliant?
Yes. All Formisoft templates, including the Mental Health Intake Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 13 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Mental Health Intake Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Mental Health Intake Form for your practice. Set up in minutes.
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