The Mental Health Screening Form Template by WPForms is a great way to manage patient intakes while screening their current mental health condition to provide them with more tailored care in advance.
How Does the Mental Health Screening Form Template Work?
The Mental Health Screening Form Template requires the WPForms Pro License, since it uses the Signature Addon to receive consent from the patient seeking mental health assistance. Here’s a brief description of the fields included:
- Patient Information:
- Name: Collects the full name of the patient for record-keeping purposes.
- Gender Identity: A field to respect and acknowledge the patient’s gender identity.
- Preferred Pronouns: Ensures respectful communication.
- Date of Birth: Important for age-specific mental health considerations.
- Phone: A direct line for communication and follow-ups.
- Email: Essential for electronic correspondence and updates.
- Mental Health Details:
- Brief Description: A space for patients to describe their current mental state.
- Mental Health History: Gathers information on any past mental health issues.
- Diagnoses or Conditions: Helps in understanding any previously diagnosed conditions.
- Current Treatments: Insight into what treatments the patient has undergone.
- Medications Used: Information on current or past medications for mental health.
- Preferred Provider/Facility: If the patient prefers a specific provider.
- Appointment Date/Time: Accommodates patient availability for appointments.
- Comments/Instructions/Requests: Allows patients to voice any special needs.
- Consent to Receive Mental Health Care:
- Consent Checkbox: A vital legal requirement for seeking mental health treatment.
- Signature and Date: Formalizes the submission/agreement to the screening process.
Sign up with WPForms today and access the Mental Health Screening Form Template. It is ideal for any mental health initiative, ensuring a smooth and respectful onboarding process.
