Get the free Mental Health History Form - evergreen

This document is designed to gather comprehensive mental health history and current presenting issues from students seeking assistance at a college Counseling Center.

How to fill out mental health history form

How to fill out Mental Health History Form

1. Start with your personal information: Enter your full name, date of birth, and contact details.
2. Provide emergency contact information: Include a name and phone number of someone to reach in case of an emergency.
3. Answer questions about your mental health history: Detail any previous diagnoses, treatments, or medications you have received.
4. Include family history: Mention any mental health issues that are present in your family, if applicable.
5. Note any past or current substance use: Disclose any history of alcohol or drug use that may impact your mental health.
6. Describe your current symptoms: Provide a clear description of any mental health concerns you are currently experiencing.
7. Review your responses for accuracy: Ensure all the information is correct before submission.

Who needs Mental Health History Form?

1. Individuals seeking therapy or mental health support.
2. Patients being referred for mental health evaluation.
3. People undergoing psychological assessments for employment or legal purposes.
4. Individuals participating in research studies related to mental health.

People Also Ask about

How to take a mental health history?

Ask the patient about their past psychiatric history: “Have you ever experienced symptoms like this before?” “Have you ever had any problems with your mental health before?” “Have you ever been diagnosed with a mental health problem?” “Have you ever had any treatment for your mental health before?”

How to take a mental health history?

Ask the patient about their past psychiatric history: “Have you ever experienced symptoms like this before?” “Have you ever had any problems with your mental health before?” “Have you ever been diagnosed with a mental health problem?” “Have you ever had any treatment for your mental health before?”

How do you write a mental health summary?

A good treatment summary should include: Client information (name, age, diagnosis, etc.) Summary of symptoms and conditions at the start of treatment. Interventions, therapies, and medications used (if any) Client's response to treatment and any outcomes or changes. Recommendations for future treatment.

How to write a mental health history?

Instructions for writing the one-page mental health history of your loved one: Include your loved one's name, age and insurance information on top. Note your loved one's diagnosis. List your loved one's symptoms. List your loved one's medications and other drug use, including overdoses.

How to write a story about your mental health?

Follow these steps to get on your way. Research. Make sure you know what you're talking about. Do not generalize. Despite mental illnesses being categorized, recognize that people are different. Stigmatization vs. Romanticization. Reflect, reflect, reflect. Ask yourself why you want to write about mental health.

What is an example of a psychiatric history?

For example, “Chris has had on and off thoughts of ending his life for about 2 yrs now. It started after he separated from his partner. He noticed that everytime he drinks alcohol, for the next 48 hours, these suicidal thoughts increase.

How to get a health history form?

How you make your request will depend on your provider's processes. You may be able to request your record through your provider's patient portal. You may have to fill out a form — called a health or medical record release form, or request for access — send an email, or mail or fax a letter to your provider.

How to write past psychiatric history?

The key is to start with their current well being not when they were referred several years ago. The details of referral several years ago is part of the person's past psychiatric history. If this is extensive, summarise the pertinent points.

For pdfFiller’s FAQs

What is Mental Health History Form?

The Mental Health History Form is a document used to collect information about an individual's mental health background, including past diagnoses, treatments, and any relevant personal or family history.

Who is required to file Mental Health History Form?

Individuals applying for certain licenses, such as firearms permits, or those undergoing specific background checks may be required to file a Mental Health History Form.

How to fill out Mental Health History Form?

To fill out the Mental Health History Form, one must provide personal information, details of past mental health treatments, medications, diagnoses, and any relevant medical history, ensuring all information is accurate and complete.

What is the purpose of Mental Health History Form?

The purpose of the Mental Health History Form is to assess an individual's mental health stability and suitability for specific licenses or roles, ensuring safety and compliance with legal requirements.

What information must be reported on Mental Health History Form?

The information that must be reported includes personal identification details, history of mental health diagnoses, treatments received, names and contact information of healthcare providers, and any prescribed medications.