Mental Health Risk Assessment Template
Personal Information
Full Name
Date of Birth
Gender
Contact Information
Mental Health History
Any Prior Diagnosis?
Family History of Mental Health Issues?
Details (if any)
Current Symptoms
Describe any current symptoms
Duration of Symptoms (weeks/months)
Impact on Daily Life
Risk Factors
History of Substance Use?
Previous Trauma or Abuse?
Other Relevant Risk Factors
Protective Factors
Identify any protective/supportive factors
Assessor’s Notes
Additional Comments or Observations