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The document is an Adult Intake Assessment Form created by Dr. Jason G. Stentoumis, a licensed psychologist. It is designed to collect comprehensive personal, medical, and psychological information from clients seeking therapy. The form includes sections for identifying information, occupational and marital status, education, reasons for seeking treatment, history of problems, substance use history, family background, health/medical information, and personal interests. The goal is to gather relevant data to better understand the client's needs and facilitate effective treatment.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an intake checklist?

Its a set of questions designed to understand your needs, preferences, and details. An intake form is a meticulously structured document to systematically gather essential information from clients, customers, or individuals seeking specific services.

What is included in an intake assessment?

Intake Forms and History Collection These documents will inquire about your personal and family medical history, life history, employment and educational background, and potential substance abuse issues. You will also be expected to provide details regarding the length and severity of your present symptoms.

What are good deep questions to ask?

Deep questions to ask family What excited you today? What are you feeling grateful for today? What was missing from your life this week? About what have you been proud of yourself for this week? What are you eager to feel more confident about in the next few weeks? What word would you use to describe our family?

What are good intake questions?

Patricia C. Packard Ph.D. Intake Interview Questions. What are stressors in your life currently? Mental and Physical Health History. Previous diagnosis? Any current or prior thoughts of hurting your self? Do any of your immediate family members have history of mental health issues?

What are 7 questions a psychologist would ask?

During therapy, clients are often asked questions to help them tune in to their immediate experiences, such as: What are you feeling? What are you thinking? How does your body feel right now? What are you seeing and doing in this very moment? What sounds do you hear around you?

intake assessment examples

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What is an example of assessment in counseling?

Examples include standardized tests, questionnaires, inventories, checklists, and rating scales.

What are some fun questions for counselling?

Therapeutic Questions for Youth What is the best compliment you have received? In your opinion, what is the best song ever written? If you could know one thing about the future, what would it be? What is something you feel nervous about right now? What is your happiest memory?