Psychiatry Intake Form
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Psychiatry Intake Form
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The Psychiatry Intake Form is purpose-built for psychiatric medication management practices, capturing the comprehensive psychiatric history that psychiatrists and psychiatric nurse practitioners need for diagnostic assessment and pharmacologic treatment planning. This template collects patient demographics alongside a detailed psychiatric symptom review covering mood disorders (depression, mania, hypomania), anxiety disorders (generalized anxiety, panic, social anxiety, OCD, PTSD), psychotic symptoms (hallucinations, delusions, disorganized thinking), ADHD symptoms, eating disorder screening, and personality disorder features. Each symptom domain includes onset, severity, and functional impact.
Designed for general psychiatry, psychopharmacology, consultation-liaison, forensic psychiatry, and addiction psychiatry practices, this form includes sections for psychiatric medication history (all prior trials with dosages, durations, reasons for discontinuation, and side effects), psychiatric hospitalization history, ECT or TMS treatment history, substance use assessment (type, quantity, frequency, last use, withdrawal history), and detailed family psychiatric history. The safety assessment section screens for current and past suicidal ideation, suicide attempts, self-harm, homicidal ideation, and access to means.
All fields are HIPAA-compliant and designed with the psychiatric evaluation workflow in mind. The comprehensive pre-visit documentation allows the psychiatrist to review the full medication trial history, identify patterns of treatment response, and arrive at the consultation prepared to discuss diagnostic impressions and medication recommendations. The safety screening ensures that high-risk patients are identified before the first appointment, allowing for appropriate safety planning.
What's included
- Comprehensive psychiatric symptom review
- Medication trial history with responses and side effects
- Substance use and withdrawal assessment
- Suicide risk and safety screening
- Psychiatric hospitalization and treatment history
- Psychosocial and family psychiatric history
- Emergency contact information
- E-signature capture
- Structured medication list with dosage and frequency tracking
Who uses this template
- General psychiatry and psychopharmacology practices
- Psychiatric nurse practitioner clinics
- Addiction psychiatry and dual-diagnosis programs
- Consultation-liaison psychiatry services
All form fields
16 fields across 4 pages. Customize any field after signing up.
How to use the Psychiatry Intake Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Psychiatry 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 Psychiatry 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 16 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 Psychiatry Intake Form HIPAA compliant?
Yes. All Formisoft templates, including the Psychiatry 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 16 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 Psychiatry 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 Psychiatry Intake Form for your practice. Set up in minutes.
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