Intake Assessement Form

 
As you become more familiar with the various forms of psychopathology, you will realize that collecting an accurate and specific history of a client’s psychosocial profile is a key element that can assist in establishing a diagnosis.
In this assignment, complete the following:

Develop an intake assessment form for your future clinical practice. The form should provide the necessary information for you to make a competent diagnosis.
Your intake assessment form should be written as a three- to four-page questionnaire with questions to aid in gathering relevant information to do the following:

Form diagnostic impressions
Complete a differential diagnosis

Your questionnaire should tap into key areas of developmental, social, emotional, medical, behavioral, psychological, and athletic performance functioning.
Your intake assessment form should contain the following components:

Identifying information
Presenting problem
Symptomatology
Developmental history
Educational history
Family history
Medical history
Athletic/performance history

Develop specific questions to obtain detailed information about these components. You are welcome to review intake assessment measures you have access to professionally, or you can conduct research to locate and view examples of intake assessment forms.
The level of detail within these sections is up to your discretion as well as the inclusion of additional components (such as checklists or diagrams).