Get the free Counseling Intake Questionnaire

This document is a counseling intake questionnaire used by Bastyr University. It collects personal client information, presenting concerns, mental health history, family background, lifestyle questions, and goals for counseling. The questionnaire is designed to help the counselor understand the client\'s needs and issues in order to develop an appropriate course of action.

How to fill out counseling intake questionnaire

How to fill out counseling intake questionnaire

1. Begin with personal information: Fill in your name, date of birth, address, and contact details.
2. Provide insurance information: Include details about your insurance provider and policy number, if applicable.
3. Describe your reason for seeking counseling: Be concise but specific about your concerns or issues.
4. List any relevant medical history: Mention any past or present medical conditions, medications, and therapists.
5. Outline your goals for counseling: Share what you hope to achieve or work on during your sessions.
6. Answer demographic questions: Complete any questions regarding your gender, ethnicity, and occupation.
7. Fill out lifestyle and social history: Note details about your support system, relationships, and lifestyle choices.
8. Review and sign the document: Ensure all information is accurate and sign where required.

Who needs counseling intake questionnaire?

1. Individuals seeking mental health support or guidance.
2. People who want to address personal challenges, trauma, or emotional difficulties.
3. Those looking for strategies to cope with stress, anxiety, or depression.
4. Clients who require a structured approach to personal development.
5. Individuals pursuing relationship counseling or family therapy.

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What is counseling intake questionnaire?

A counseling intake questionnaire is a form used to collect essential information from clients before beginning counseling services. It helps the counselor understand the client's background, current issues, and goals.

Who is required to file counseling intake questionnaire?

Individuals seeking counseling services are generally required to fill out the counseling intake questionnaire as part of the initial assessment process.

How to fill out counseling intake questionnaire?

To fill out the counseling intake questionnaire, clients should carefully read each question and provide honest and detailed responses. It's essential to cover personal information, mental health history, and specific concerns or goals.

What is the purpose of counseling intake questionnaire?

The purpose of the counseling intake questionnaire is to gather relevant information that helps the counselor tailor the therapeutic approach to meet the client's unique needs and objectives.

What information must be reported on counseling intake questionnaire?

Typically, the information reported includes personal details, contact information, medical history, mental health history, current symptoms, and any previous counseling experiences.