Template library · Assessments & screeners
General Mental Health Screen template
Rate how often you have experienced the following in the past 2 weeks.
Broad mental health screening tool
- 21 fields across 4 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
Symptom Frequency
- 1. Low or depressed moodChoice
- 2. Feelings of hopelessnessChoice
- 3. Feeling anxious or on edgeChoice
- 4. Difficulty enjoying usual activitiesChoice
- 5. Withdrawing from friends or familyChoice
- 6. Difficulty functioning at work or schoolChoice
- 7. Trouble sleepingChoice
- 8. Physical symptoms affecting your mood (pain, fatigue)Choice
Risk Flags
- Thoughts of self-harm or suicideTick box
- Significant recent loss or stressorTick box
- No current support systemTick box
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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