FREE 9+ Mental Health Providers Intake Forms in PDF | MS Word

According to a survey, there is almost twenty percent of American adults who are diagnosed with mental health disorders and illnesses every single year. These illnesses include depression, anxiety, and even bipolar disorders. However, the illnesses and disorders are not only limited to adults but also those who fall under the minority age range. Since the numbers are growing for people with mental health issues, health care providers must assure that they can document every patient and client that they have. This will be done with the aid of several documents and mental health providers intake forms.

What Are Mental Health Providers Intake Forms?

Mental health providers intake forms are documents that mental health providers such as psychiatrists, psychologists, and mental health consultants use for their clients. The form is required to be filled out by the client before any sort of consultation will be scheduled and will take place in the provider’s office. With the form, the client will be able to introduce himself to the consultant and practitioner as well as inform them about his main issues and concerns relating to his mental health.

Mental Health Intake Form Sample

Significant Sections Found in Mental Health Providers Intake Forms

Regardless of the varieties that the Internet can offer for intake forms that mental health providers use, it is significant to know and distinguish sections or areas that must be filled out completely by the client. Listed below are five of the common yet important sections, aside from the client information area, which should be present in any mental health provider intake form:

• List of concerns – This must highlight the client’s medical condition and current state in order for the mental health provider in knowing what subject and matter they will be dealing during the client’s scheduled consultation.

• Psychiatric and medical history – This is for allowing the client to disclose his mental and medical information along with the past diagnosis that he had from his health care provider. The client must indicate the symptoms that he is currently experiencing along with the illness that he had previously.

• Family, substance, and developmental history – Along with the aforementioned medical history, the client’s family, substance usage, and developmental history will further determine what factors have affected the client’s current mental health.

• Spiritual beliefs – With the client’s listed beliefs, the consultant or health care provider will be able to adjust as well as limit himself from causing a misunderstanding and religious or belief conflict with the client.

• Recreation and routines – This will center on acknowledging what activities have acquired the client’s interests and are necessary to be accomplished by the client day to day.

Mental Health Counselling Intake Form

How to Maximize Mental Health Providers Intake Forms

There are different sections to add to a ready-made intake form in order to gather more details and information about the client. One of the most common add-on to incorporate in the form is a formal letter of notice. This is significant for informing the client, and his legal guardian or parent if he is a minor, regarding the intention of the mental health provider in collecting his details. The letter must be placed on the primary page of the form or can be enclosed as a separate document.

Another is a care coordination recommendation section which is ideal for knowing the identities of the person who recommended the provider’s services and expertise to the client. This can be indicated in the last area of the form along with the contact details of the recommending personnel.

Lastly, a consent to treat is the most significant to include in any intake form especially if the intention of the client is to have his issues addressed and treated by the consultant or practitioner. With this, an agreement can be stated in order to acknowledge the roles and the obligations of the client in providing sufficient payment for each consultation and in assuring that he will be present on the day of his consultation schedule. Additionally, the agreement can include an area that is addressed to the parent of the client to secure that they have agreed on the capabilities and the limitations of the consultants and practitioners.

Neurofeedback Minor Child Intake Form

Five Examples of Mental Health Providers Intake Forms

Although there are tons of mental health issues, illnesses, and concerns that are evident in today’s generation, the types of intake forms and documents to be used to cater these concerns are general and often in a uniform format. Nonetheless, below are some of the common varieties or examples of mental health providers intake forms that are used by consultants for their patients and clients:

Adult Mental Health Intake Form – This type of mental health intake form is only suitable to be used by people who are no longer in the minority age. In this form, the user will have to disclose his general information on the first section which includes his name and date of birth along with the specific date of when he is visiting the clinic. The form mostly contains questions that are focused on determining the mental health issues of the user such as whether he had been into a previous psychological counseling before and if he is a drug abuser. Other details needed to complete this document includes the user’s list of his own strengths, weaknesses, recreational activities, and the name of his primary care provider.

Adult Mental Health Intake Form

Mental Health Child Intake Form – In contrary to the aforementioned adult mental health intake form, this document is to be used by clients who are below the minority age and must be completed with the supervision of their legal guardian. The first section of the form centers on gathering sufficient child information which includes the child’s name, gender, age, and the names of the child’s parents. If it is the parent or the child’s legal guardian who is filling in the fields of the form, then he needs to indicate his main reason of why he aims to have the child a therapy session or consultation with a mental health provider. The second section of this form contains a problem and symptom checklist which is significant for determining what issues are evident to the child ranging from sleep problems to being consistent in causing fights and arguments. Other sections of the form highlight the names of the child’s siblings, the child’s school record or history, and a list of the child’s traumatic incidents.

Mental Health Child Intake Form

Mental Health Intake and Evaluation Form – This type of intake form has an accompanying section that will allow the consultant in stating what evaluation method is necessary for addressing the client’s concerns. However, before the evaluation method section, the client will need to fill out his name, medical record number, date of birth, age, and other relevant personal information to aid in identifying himself to the consultant. In the event that the client was referred to the mental health professional by his physician or primary care provider, he needs to disclose the reasons why the medical referral was made. Along with the reason is the indication for the type of medical and mental health services that the client took previously such as various medical exams and tests. In addition to this, the client’s moods, though process, and the final evaluation of the mental health professional regarding the client’s concerns are also needed to complete the intake form.

Mental Health Intake and Evaluation Form

Mental Health Services Intake Referral Form – Compared to other intake forms, this document is necessarily used by the mental health care provider of a patient or client. The form serves as an initial assessment tool which is completed by having the client undergo a series of interviews and tests before he will be referred to the appropriate clinic where he will be treated. Since this is a form a referral slip, the physician will have to indicate whether the treatment must be made in an urgent manner or if the client’s concerns and mental health problem is only a mild case. At the end of the document, the physician must affix his signature to prove that what he disclosed and stated were based on the medical test results of the client.

Mental Health Services Intake Referral Form

Student Mental Health Counseling Intake Form – Basically, this form is provided by the school administration to their students who need to be assessed by mental health professionals. The form will state whether the student is a full-time or a part-time student in the institution along with details on the student information section. A checklist allotted for the various problems and issues relating to a student’s mental health is indicated in another section with a few questions to be answered by the student. Once completed, the student must submit a duplicate of the form to his adviser or teacher as a notice that the student needs to take a mental health consultation.

Student Mental Health Counseling Intake Form

Why Incorporate a Confidentiality Agreement on Mental Health Providers Intake Forms?

The intention of having a confidential agreement is to inform the client that his information and disclosed medical details will not be used by other parties without his consent. This promotes trust and security to the client as well as implies that the mental health care providers consider their client’s details as valuable matters to be kept within the organization only.

On the other hand, the confidentiality agreement also allows the consultant in providing a better service to the client since it will limit the client in disclosing the details of his sessions to other entities and individuals if a resolution is not yet met. With this, the client will not be causing any person to interrupt the services and the plans of the consultant for addressing the client’s mental health issues and concerns.

Lastly, the confidentiality agreement is also part of the regulating laws that consultants and practitioners need to follow and comply. In the event that confidentiality and privacy are both not observed as well as mandated by a consulting firm, then it will be necessary for the client to inform the consultant that he demands his information be kept private or report the firm or clinic to the authorized agency in the state who handles policies about confidentiality and privacy.

Confidential Mental Health Intake Form

Benefits of Using Mental Health Providers Intake Forms in DOC

With the varieties of mental health provider intake forms, any consultant and mental health care practitioner will be able to acquire enough details about his clients. However, a consultant must determine what format he will use for his services whether he will be using an online document format or a printed intake form. Among the online document formats that can be obtained through our site, the consultant can choose between a form in PDF format or in a DOC format. If he prefers the document in DOC format, he will be assured of several advantages of benefits as he begins using the form.

One benefit that the consultant can acquire is that a DOC format allows him to easily manipulate and edit every part of the form from the header to the very last section. Another known benefit of this format is that it can be updated whenever there is a need to do so. The DOC format can also be incorporated into a password to secure that the fields will not be interchanged by anyone aside from the authorized personnel of the consultation clinic.

Nonetheless, compared to other formats, a DOC file is the most common and the most understood format by any user. This can be placed on the website of the consultation clinic, as well as can be sent through an electronic mail addressed to the consultant’s clients and patients.

Mental Health Client Intake Form in DOC

Importance of Mental Health Providers Intake Forms

Mental health providers intake forms are significant documents since these serve as tools for the providers and consultants in identifying their clients individually along with their needs. Once it is completed, the consultant will be able to distinguish the causes of the client’s concerns and what resolution will be appropriate to address each disclosed issue. Specifically, the form aids in the communication between the client and the consulting staff since there are medical questionnaires incorporated on the document in order to obtain detailed answers from the client.