Ultimate, Mother-of-All COUPLES INTAKE QUESTIONNAIRES
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I work with a few employee assistance programs (EAP) and they have been starting to refer couples to me.  My intake questionnaire for individuals was simply not inclusive enough.  So, with some modifications on the Mother-of-All Intake Questionnaires, I created the attached.  Please note any checkbox that is clicked will prompt a multi-line text box for more information.   If you can think of anything you believe would be worth adding, please let me know.  If you want the form shared in Simple Practice, vote for it by clicking the heart icon to the left of my picture:

https://drive.google.com/file/d/1qoRp90vESOvLGr4E7AfJrfbwIrBCcErg/view?usp=sharing 

4 comments

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    Joshua Cress

    WOW! The name does not disappoint! This is fantastic, very thorough and clinically helpful. Is there a way to add this to our portal? -Josh

    WOW! The name does not disappoint! This is fantastic, very thorough and clinically helpful. Is there a way to add this to our portal? -Josh

  • Avatar
    Ryan Buchmann

    Not yet. I suggest downloading the PDF and copy/pasting text to the form you can create in your SP account.  Remember, when writing your questions, make sure they are as strength-based as possible.  For example, how would you rephrase the question "Has there ever been a history of abuse or domestic violence in the relationship?" so that it is more strength-based or less threatening?  For example, "Has your partner ever caused you to feel afraid of him/her or hurt your feelings?"  OR "What have you seen happen when your partner gets really angry?" OR "What have you noticed causes your partner to become angry at you?"  For those of you who work with DV couples, please share other (or better) question ideas.

    Edited by Ryan Buchmann

    Not yet. I suggest downloading the PDF and copy/pasting text to the form you can create in your SP account.  Remember, when writing your questions, make sure they are as strength-based as possible.  For example, how would you rephrase the question "Has there ever been a history of abuse or domestic violence in the relationship?" so that it is more strength-based or less threatening?  For example, "Has your partner ever caused you to feel afraid of him/her or hurt your feelings?"  OR "What have you seen happen when your partner gets really angry?" OR "What have you noticed causes your partner to become angry at you?"  For those of you who work with DV couples, please share other (or better) question ideas.

  • Avatar
    Elizabeth Hocker

    Thanks for sharing! I wish this was one that SP could upload!

    Thanks for sharing! I wish this was one that SP could upload!

  • Avatar
    Gina Mills LCSW, LLC

    Thank you for sharing this!  I would vote if I knew how!

    Thank you for sharing this!  I would vote if I knew how!