About this template
This Psychological Assessment Form is designed for mental health professionals to streamline the collection of patient history, symptom severity, and psychological well-being. By moving away from paper-based intake, clinicians can gather consistent, structured data before or during the initial consultation, allowing for more focused and effective therapy sessions.
This template covers a wide range of clinical metrics, including mood stability, anxiety symptoms, trauma impact, and physical manifestations of stress. It is built to be comprehensive yet user-friendly for the patient. Using Doc2Form, you can easily deploy this template to your Google Drive, ensuring that all patient responses are automatically organized into a secure spreadsheet for your review. This approach minimizes administrative overhead, allowing you to dedicate more time to patient care and clinical analysis.
Key features
- Standardized rating scales for symptom tracking.
- Comprehensive sections covering mood, anxiety, and physical symptoms.
- Easy integration with Google Sheets for clinical documentation.
- Clear, professional layout to reduce patient anxiety during intake.
- Fully customizable to fit your specific therapeutic approach.
Use cases
- Initial patient intake and history taking.
- Routine progress monitoring during ongoing therapy.
- Pre-screening for specialized trauma or anxiety treatment programs.
- Clinical research data collection.
What this form collects
- Full Name (Short answer)Please provide your full legal name.
- Date of Assessment (Date)Select today's date.
- I feel overwhelmed by my current situation. (Linear scale)1 = Never, 5 = Constantly.
- I have experienced a loss of interest or pleasure in activities. (Linear scale)1 = Not at all, 5 = Extremely.
- I experience heart racing or palpitations. (Linear scale)1 = Never, 5 = Frequently.
- I have noticed changes in my sleep patterns. (Paragraph)Describe your recent sleep quality (e.g., insomnia, oversleeping).
- Additional Comments (Paragraph)Is there anything else you would like your therapist to know?
- Patient Signature (Short answer)Please type your full name to acknowledge that the information provided is accurate to the best of your knowledge.
FAQ
Can I add my own clinical questions?
Yes. Once you import this template into your Google Drive, you can add, remove, or modify any questions to align with your specific clinical methodology or diagnostic criteria.
How do I review the patient responses?
All submissions are automatically saved to a Google Sheet linked to your form. You can use the built-in analysis tools in Sheets or export the data to your preferred electronic health record (EHR) system.
Is this template suitable for all types of therapy?
The template is designed as a broad psychological assessment. You may want to customize it to focus more on specific areas like cognitive-behavioral markers or trauma-informed care depending on your practice's focus.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.