Revised Intake form w/ multi-choice items for SI, drinking, drug use
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Revised the standard intake form with some additional items I've found helpful in the past. Also changed the items for suicide attempts, drinking and drug use to multiple choice - think it can be easier to capture specific info on potentially difficult topics using prompts rather than free field.  Items are adapted from Kaiser and a couple of primary care brief screeners. 

Would love feedback, particularly about other specific items you've found to be useful. Feel free to adapt this for your own use if you'd like. 

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Hi Angela, 

Thanks for catching the slip! And, had already revised the initial revision, with an item tracking referral sources in greater detail.

Let's try again - link to rev2 file on Google Drive

These things are a work in progress - is it too long? is it missing something important? will it work? etc. 

Feedback greatly appreciated!

2 comments

  • Avatar
    Angela DeGiaimo

    The files you linked is actually your consent to release information form.

    The files you linked is actually your consent to release information form.

  • Avatar
    Laura E. Forsyth

    Hi Angela, 

    Thanks for catching the slip! And, had already revised the initial revision, with an item tracking referral sources in greater detail.

    Let's try again - link to SP Intake Ques Rev2 (google drive)

    BTW, all my stuff is a total work in progress, and this intake questionnaire is no exception. Am already wondering it's too long or missing something important. Time and use will tell... Feedback and any suggestions greatly appreciated!

    Hi Angela, 

    Thanks for catching the slip! And, had already revised the initial revision, with an item tracking referral sources in greater detail.

    Let's try again - link to SP Intake Ques Rev2 (google drive)

    BTW, all my stuff is a total work in progress, and this intake questionnaire is no exception. Am already wondering it's too long or missing something important. Time and use will tell... Feedback and any suggestions greatly appreciated!