Ultimate, Mother-of-All Intake Questionnaires
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My intake questionnaire is an evolution of months of working with clients.  I want to make it available for everyone to use in their own practices.  I pretty much have it nailed down for collecting the information I need to hit the ground running when starting with a new client.  I share it when scheduling the first appointment with the client using the Client Portal and the completed form is added directly to the client's new EHR.  If you find it helpful, please vote for it so it gets added to the template library.

Note on the long-answer questions, first, the question must be answered, and second, if the client tics a checkbox or answers any question "yes," the form will prompt them to add additional information.  Also note that the four areas of personal health that I find most important to assess are sleep, diet, exercise, and enjoyable activity (e.g. hobby).  I figure if they have all four of these areas going well, then their problem may be organic and requires the involvement of a medical doctor.  Otherwise, a deficiency may be a good start for the conversation.

I apologize in advance if the questions seem out of order, but that is how the screenshots were imported into this post.

You can download the PDF version by clicking here.





9 comments

  • Avatar
    Anne Marie Brooks, LMSW

    Great stuff, Ryan! I'd love to see this as a new template! I use the one in there already because I'm too busy with the other new and crazy things that go along with opening a newer private practice! The template in there currently is sorely lacking and this one gathers much more information! Love it and I hope others vote for it! Hope to see it in SP soon! Thank you for creating it!

    Great stuff, Ryan! I'd love to see this as a new template! I use the one in there already because I'm too busy with the other new and crazy things that go along with opening a newer private practice! The template in there currently is sorely lacking and this one gathers much more information! Love it and I hope others vote for it! Hope to see it in SP soon! Thank you for creating it!

  • Avatar
    Eve Schutt

    I'll vote for you.  I already have one that I use but I don't know how to do screenshots to add it here,  I agree the one in the system is currently lacking. The reason I went with SP is so I can make my own templates.

    I'll vote for you.  I already have one that I use but I don't know how to do screenshots to add it here,  I agree the one in the system is currently lacking. The reason I went with SP is so I can make my own templates.

  • Avatar
    Donna Rose

    Thanks, Ryan! Appreciate you sharing and offering your rationale on certain questions. Great!

     

    Thanks, Ryan! Appreciate you sharing and offering your rationale on certain questions. Great!

     

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    Markita Thompson

    Yes. i would definately use this template. It is more detailed and will decrease my interviewing time. 

    Yes. i would definately use this template. It is more detailed and will decrease my interviewing time. 

  • Avatar
    Stephanie Herbert

    I will vote as well. Very thorough.

    I will vote as well. Very thorough.

  • Avatar
    Wendy Romero

    I like this form. Is there any other way to share it other than me having to recreate it myself? Good job and very thorough.

    I like this form. Is there any other way to share it other than me having to recreate it myself? Good job and very thorough.

  • Avatar
    Mawiyah Kambon

    Although I like this I created one with a few more details I have found relevant. I'm not sure what a vote would do as we have the opportunity to alter or create one.

    Although I like this I created one with a few more details I have found relevant. I'm not sure what a vote would do as we have the opportunity to alter or create one.

  • Avatar
    Thomas Hornbeck

    This is great!  Thanks Ryan!  I'm hoping SP will add this to the templates soon.  Keep voting for it!

    This is great!  Thanks Ryan!  I'm hoping SP will add this to the templates soon.  Keep voting for it!

  • Avatar
    Megan Clifford

    HI Ryan- If I put it in as a PDF is the client able to fill it out and return it to me electronically or do they just bring it to the first session?

     

    HI Ryan- If I put it in as a PDF is the client able to fill it out and return it to me electronically or do they just bring it to the first session?