Clinical Mental Health Intake Form
This comprehensive intake form helps your clinician prepare for your care. Please complete all sections honestly — there are no right or wrong answers.
Step 1 of 9Demographics
1
Demographics2
Presenting Concerns3
History4
PHQ-9 & GAD-75
PCL-5 (Trauma)6
SCL-90 Screener7
Sentence Completion8
Early Recollections9
Goals & ConsentPersonal Information
This information helps us provide you with the best possible care.
Emergency Contact
Background
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