Psychiatric Evaluation Form Template

Pre-appointment QuestionnaireHi there, what's your name?What are you struggling with, and how can we help?Are you aware of any family members who experience the same issue? Have you received any treatment before for the same issue? Thanks, {{field:146ad844-fadf-4bbb-a940-240c4dfc3d12}}. How do you identify?

Female, Male, Non-binary, Prefer not to say

And how old are you?Thanks a lot, {{field:146ad844-fadf-4bbb-a940-240c4dfc3d12}}. That's all the info we need for now.

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The easier way to learn about patients

Fast-track your treatment by learning about patients' symptoms and medical history ahead of their appointment. By planning ahead, you'll be able to help them as soon as they arrive, without worrying about the paperwork.

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Psychiatric evaluation form FAQs:

A psychiatric evaluation form is used to get a better understanding of patients and their medical history. You can use it to find out how long patients have been having symptoms, and if they've ever had a diagnosis.

You can also ask for individual and family medical history, or if they've been treated in the past.

Whatever you need to know, you can chop and change the question types to suit you and your patients' needs.

With Typeform, it's super easy. There's no development or coding involved, and you don't even need to be techy. Our interface is intuitive and accessible, meaning anyone can make a professional-looking form in a matter of minutes.

Feel free to use our template as a base, and build on it as you see fit. When you're happy with your form, hit publish, plug it into your most-used apps and start collecting requests.

Before you send out your form, there are two things you should do:

Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.