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.
05-26-21 V2 Update: I just added questions pertaining to infidelity, religion and spirituality, cultural issues, gender and sexual identity, and relationship violence issues. Thank you, Susan Diamond, for the great suggestions!
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:
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