Psychiatric Evaluation Form Template
Gather patient information before the evaluation so you can focus the session on what matters most.
Psychiatric evaluations require a lot of ground to cover — presenting concerns, psychiatric history, medications, family history, substance use, current functioning. When that information is collected on paper in the waiting room, patients rush through it, handwriting is hard to read, and clinicians spend the first part of every session on intake basics instead of clinical assessment.
An online pre-evaluation form changes that. Typeform's psychiatric evaluation template uses conditional logic to follow up on what's relevant — if a patient discloses a history of a specific condition, the form can surface additional questions about onset, treatment history, and current symptoms. You get complete, readable responses before the appointment starts. The form can connect to your EHR or practice management system so responses feed directly into the patient record.
You can adjust the clinical scope, add your practice's consent disclosures, and customize the form to align with your assessment framework.
A psychiatric evaluation form is a structured intake questionnaire used to collect clinical information before or during a psychiatric assessment. It covers areas like presenting concerns, mental health and medical history, current medications, and psychosocial background to help the clinician conduct a thorough evaluation.
It makes your evaluations more efficient and more complete. When patients provide background information in advance, clinicians can review it before the session and focus their clinical time on assessment and rapport rather than data collection. It also creates a consistent record for every patient.
A psychiatric evaluation form typically covers:
- Presenting concerns and reason for seeking evaluation
- History of mental health diagnoses and treatment
- Current medications and dosages
- Family psychiatric history
- Substance use history
- Sleep, appetite, and daily functioning
- Any recent significant life events or stressors
All form responses should be treated as confidential patient information and stored in compliance with HIPAA or applicable regulations. Flagging certain responses — such as disclosures of self-harm or suicidal ideation — for immediate clinical review before the appointment is a common best practice.
Yes. For telehealth patients especially, a well-designed pre-evaluation form is often the first touchpoint with your practice. Sending it ahead of the appointment gives patients time to reflect on their responses and arrive better prepared for the conversation.
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