Cbt intake form 2026

1. Click ‘Get Form’ to open the CBT Intake Form in the editor.
2. Begin by filling out your Patient Information. Enter your full name, preferred name, date of birth, age, and gender. Ensure that your contact number and email address are accurate for follow-up communications.
3. Next, provide details about your Current Residence and Primary Care Physician. Indicate your marital status and rate your current relationship on a scale from 1-10.
4. Move on to the Psychiatric History section. Clearly state the primary reason for your visit and indicate if you are currently receiving mental health care. If applicable, list any past treatments or hospitalizations.
5. In the Family History section, check any relevant conditions that family members may have experienced. This information can be crucial for understanding potential hereditary factors.
6. Complete the Medical History section by listing any medical conditions and allergies. Be honest about alcohol consumption and tobacco use.
7. Finally, outline your goals for therapy and any additional information you wish to share with your doctor before signing and dating the form.

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