A mental health assessment template is the format of the document which is used to assess the mental state of an individual. Along with the personal details these types of templates contain the questions that help to assess the mental state of an individual. The need of such template mainly arises due to the fact that many times doctors or other mental health analysers might not be aware of the pattern to be followed while framing such documents. Infact a lot of times, medical experts would want to save their time and hence might require help of these templates. Their customisable nature makes them easy to use and thus widely executed by people all over the world.
You can Download the Free Mental Health Assessment Template form, customize it according to your needs and Print. Mental Health Assessment Template is either in MS Word, Excel or in PDF.
Sample Mental Health Assessment Template
Mental Health Assessment Template
Download Mental Health Assessment Template
Name of the patient: __________________
Date of birth: _______________
Address: ______________
Gender: _____________
Contact number: _______________
Date of assessment: ___________
History of mental health: _________________ [whether the individual had any mental illness]
Medications: ____________ [if under any]
Is he addicted to alcohol? _________________ [yes or no]
Is he addicted to drugs? ___________________ [yes or no]
Any history of substance abuse? ___________________ [yes or no]
Examination of mental state:
Behavior: ________________________ [details of behavior]
Mood: ______________ [what kind of mood usually the individual is in]
Thinking: ___________________ [how the thinking is affected]
Sleeping disorder: _____________________ [whether the individual gets proper sleep]
Motivation: _______________ [whether he needs motivation in life]
Energy: ________________ [whether the person is energetic]
My mental health has been assessed and it can be discussed.
_________________
Signature of the patient
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