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Mental Health History Questionnaire Template

Mental Health History Questionnaire Template

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To help you the best way possible, we will ask you some questions related to your mental health history. First, what is your first name? And your last name? What's your date of birth, {{field:01F67JQZARVHGHQR95V7YRXPV3}}? Do you have a history of any mental health illness? Please explain what mental health challenges you've had in the past, or have now. Does anyone in your family have a history of mental health illness? Please explain who in your family, and what mental health issues they have faced or are facing. Thank you for sharing your information, {{field:01F67JQZARVHGHQR95V7YRXPV3}}. We will see you at your appointment. Thanks for completing this typeform Now *create your own* — it's free, easy, & beautiful

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Ask better questions to create better treatment plans

This form is for medical professionals who value human connection and want to translate this to every part of their treatment. This questionnaire makes it easy for patients to share their mental health history safely and privately.

Mental health history questionnaire FAQs:

When a patient books an appointment, filling out this form before the first meeting will help the both of you come to the table well-prepared. Instead of asking questions on the spot, patients can fill out this mental health history questionnaire beforehand. The documented data will also help you create better treatment plans. Less guesswork, less stress.

With this questionnaire privacy is of the utmost importance. Typeform is GDPR-proof and no manual work is needed to transfer answers into your patient files, thanks to our integrations.

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. Do this 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.