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    Intake Interview

    Uploaded by

    Marky Laury Gameplays
    The document appears to be an intake form for counseling clients. It contains sections for collecting a client's general information, medical history, and personal, family, and social histories. The form explains that answering the questions can help the counselor better assist the client, but answers are optional. It also notes follow-up questions may be asked based on the client's responses. The goal is to increase the counselor's ability to be helpful to the client.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Intake Interview

    Uploaded by

    Marky Laury Gameplays
    222 views6 pages
    The document appears to be an intake form for counseling clients. It contains sections for collecting a client's general information, medical history, and personal, family, and social histories. The form explains that answering the questions can help the counselor better assist the client, but answers are optional. It also notes follow-up questions may be asked based on the client's responses. The goal is to increase the counselor's ability to be helpful to the client.

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    The document appears to be an intake form for counseling clients. It contains sections for collecting a client's general information, medical history, and personal, family, and social histories. The form explains that answering the questions can help the counselor better assist the client, but answers are optional. It also notes follow-up questions may be asked based on the client's responses. The goal is to increase the counselor's ability to be helpful to the client.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    222 views6 pages

    Intake Interview

    Uploaded by

    Marky Laury Gameplays
    The document appears to be an intake form for counseling clients. It contains sections for collecting a client's general information, medical history, and personal, family, and social histories. The form explains that answering the questions can help the counselor better assist the client, but answers are optional. It also notes follow-up questions may be asked based on the client's responses. The goal is to increase the counselor's ability to be helpful to the client.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 6

    Mark Lauren D.

    Pilapil

    Psychology Student

    7a Bayaya, St. San Francisco Del Monte,

    Quezon City, Metro Manila

    Client Information Form

    Intake Interview

    Client’s name: __________________________ Date: ______________

    OK to thank referrer? Yes__ No__ Client Phone #: ____________ Date of Birth: _______

    Intake Interview Questions

    The following questions may


    help me to better assist you in
    the counseling process. If
    for any reason, you do not want
    to answer the questions, you do
    not have to. You may
    leave any question blank.
    During the course of therapy, I
    may ask follow up questions
    based on your answers. Again
    these questions and the answers
    you provide may likely
    increase my ability to be
    helpful.
    The following questions may
    help me to better assist you in
    the counseling process. If
    for any reason, you do not want
    to answer the questions, you do
    not have to. You may
    leave any question blank.
    During the course of therapy, I
    may ask follow up questions
    based on your answers. Again
    these questions and the answers
    you provide may likely
    increase my ability to be
    helpful.
    The following questions may
    help me to better assist you in
    the counseling process. If
    for any reason, you do not want
    to answer the questions, you do
    not have to. You may
    leave any question blank.
    During the course of therapy, I
    may ask follow up questions
    based on your answers. Again
    these questions and the answers
    you provide may likely
    increase my ability to be
    helpful.
    The following questions may
    help me to better assist you in
    the counseling process. If
    for any reason, you do not want
    to answer the questions, you do
    not have to. You may
    leave any question blank.
    During the course of therapy, I
    may ask follow up questions
    based on your answers. Again
    these questions and the answers
    you provide may likely
    increase my ability to be
    helpful.
    The following questions may help me to better assist you in the process. If for any reason, you do not
    want to answer the questions, you do not have to. You may leave any question blank. During the
    course, I may ask follow up questions based on your answers. Again these questions and the answers
    you provide may likely increase my ability to be helpful.

    I.GENERAL QUESTIONS :

    1. What is your reason for coming in today?

    2. Can you tell me more about your case?

    3. What are your goals? What outcome would you like to see?

    4. What expectations do you have of your mind?

    5. Do you have additional documents or information for me?

    II. MEDICAL HISTORY OR ANOTHER FINDINGS

    1. What is your prior mental health history


    2. Any prior treatment? For what? When? Where?

    3. Prior hospitalizations? When? Where?

    4. Any current or prior thoughts of hurting your self? If yes, explain?

    5. Do any of your immediate family members have history of mental health issues? If yes, which
    family members and nature of issue?

    III. Personal, Family, and Social Histories

    1. How healthy is your family?

    2. Tell me a little about your home?

    3. How much sleep do you get a night?

    4. Do you feel hopeful about the future? What do you think of yourself?

    5. What methods do you use to deal with stress? Have there been any prominent stressful events
    in your life lately?

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