Initial self evaluation form 2026

1. Click ‘Get Form’ to open the initial self evaluation form in the editor.
2. Begin by entering your name and the date at the top of the form. This helps personalize your evaluation.
3. In the section asking for your referral source, provide the name of the person or organization that referred you.
4. Clearly state your reason for seeking therapy in the designated field, ensuring you express any specific concerns.
5. Use the provided diagram to mark areas of discomfort. Label each area with descriptors like 'Severe' or 'Aching' as applicable.
6. List and rate each symptom on a scale from 0 to 10, where 0 indicates no pain and 10 represents extreme pain. Fill out all relevant fields.
7. Answer questions regarding when symptoms began, potential causes, and factors that worsen or ease your symptoms.
8. Complete additional sections about sleep patterns, previous treatments, medications, and personal goals for therapy.

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