Template library · Intake forms
Full Biopsychosocial Intake template
Comprehensive intake covering biological, psychological, and social factors relevant to care.
Comprehensive biopsychosocial assessment
- 26 fields across 7 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Presenting Problem
- Presenting concern in client's own wordsText
- Onset and durationText
- Prior episodes and treatmentText
Biological Factors
- Medical historyText
- Current medicationsText
- Sleep, appetite, and energyText
Psychological Factors
- Mental health historyText
- Current symptomsText
- Coping styleText
Social Factors
- Family and relationship historyText
- Employment / educationText
- Housing and financial stabilityText
- Cultural and spiritual considerationsText
Risk Flags
- Current suicidal or self-harm ideationTick box
- Substance use concernsTick box
- Safety concerns in living situationTick box
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)Date
When to use it
Send an intake form when a new client books, so their history, contact details and reasons for coming are in front of you before the first appointment rather than taken down during it.
How it works in MyWellOps
- Choose it from Documents and adjust the questions to your practice.
- Send it to the client, who completes it in their client portal.
- Their answers are kept on the client’s record, ready for the first session.
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