Intake assessment examples 2025

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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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Click ‘Get Form’ to open the intake assessment in the editor.
Begin by filling out the 'Identifying Information' section. Enter your name, today's date, date of birth, and select your sex. Ensure all fields are completed accurately.
Proceed to the 'Occupation/Employment Information' section. Check all applicable boxes regarding your employment status and provide details about your current job if employed.
In the 'Marital Status' section, select your current relationship status and provide any relevant comments regarding past relationships.
Continue to the 'Education' section. Indicate your highest level of education completed and any special training or skills you possess.
For the 'Reason for Seeking Treatment', describe the issues prompting you to seek help and what you hope to achieve through treatment.
Complete the remaining sections, including 'Substance Use History', 'Family Background', and 'Health/Medical Information', ensuring that all questions are answered thoughtfully.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (73 Votes)
2016	4.2 Satisfied (65 Votes)

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What is an intake assignment?

The Brief Intake/Assessment is the initial meeting with the client during which the case manager gathers information to address the clients immediate needs to encourage his/her engagement and retention in services.

What is an intake assessment?

An intake assessment gathers detailed information about a clients background, presenting concerns, and treatment needs. This data helps therapists gain a clear understanding of the clients situation, formulate a diagnosis, and create a personalized treatment plan.

What questions are asked at therapy intake assessment?

Inquiries like Tell me about your family and your relationships with them, Can you tell me about your childhood and any docHub experiences that shaped who you are today? and Are there any cultural, religious, or personal values that are particularly important to you? can provide valuable insights into their

What are some examples of intake?

Examples from Collins dictionaries Your intake of alcohol should not exceed two units per day. Reduce your salt intake. The airline is to double the intake of its female pilots. It is important to ensure that solid objects do not enter the air intake of the jet engine.