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8300 Health Park, Suite 201 Raleigh, NC 27615 Phone: 9192302569 Fax: 9196480707 PATIENT INFORMATION Name Date Address May we send mail to the above address? Y / N Please provide numbers and Email

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01

Open the mh intake formsdocx file using a compatible word processing software.

02

Start by providing your personal information such as name, contact details, and date of birth.

03

Answer the questions regarding your mental health history, including any previous diagnoses, treatments, and medications.

04

Provide information about your current mental health concerns and symptoms.

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Save the filled-out mh intake formsdocx file for your records or as instructed by the relevant healthcare provider.

Who needs mh intake formsdocx?

01

Individuals seeking mental health services

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Psychiatrists, psychologists, therapists, and other mental health professionals

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Healthcare organizations and clinics that require intake forms for mental health assessments

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