Mental Health Initial Assessment Form
Client Information
Full Name
Date of Birth
Gender
Female
Male
Other
Contact Details
Address
Emergency Contact
Presenting Concerns
Please describe your main concern(s):
History
Mental Health History
Medical History
Substance Use
Risk Assessment
Suicidal or Self-Harm Risk
Risk to Others
Social History
Family Background
Employment/Education
Living Situation
Support System
Mental Status Exam
Appearance/Behavior
Mood/Affect
Thought Process/Content
Cognition
Insight/Judgement
Assessment & Plan
Summary/Diagnosis
Treatment Plan/Recommendations