Trauma-Informed Mental Health Assessment
Client Information
Full Name
Date of Birth
Gender
Assessment Date
Presenting Concerns
Describe Current Concerns
Trauma History
History of Trauma (types, age, frequency, duration)
Impact of Trauma
Current Symptoms
Psychological Symptoms
Physical Symptoms
Dissociation Symptoms
Resilience & Strengths
Client Strengths
Coping Strategies
Support Systems
Family & Friends
Community & Professional Resources
Risk Assessment
Self-Harm or Suicidal Thoughts/Behaviors
Harm to Others
Clinical Impressions
Diagnosis (if any)
Summary of Clinical Impressions
Treatment Recommendations
Recommendations
Clinician Information
Clinician Name
Credentials/Title
Signature