Family Mental Health Support Assessment
Family Information
Family Name
Date
Assessor Name
Contact Number
Family Members
Name
Age
Relationship
Name
Age
Relationship
Current Concerns
Describe the main mental health or wellbeing concerns in the family
Strengths & Supports
List family strengths and available supports
History
Relevant mental health history (family/individual)
Assessment Summary
Summary comments
Recommendations
Suggested support/services