3 minutes to complete
To be eligible to fill out the Forensic Mental Hospital Intake Form, an individual must be seeking admission to a mental health facility.
What is your name?
What is your date of birth?
What is your Social Security Number?
What is your current address?
What is your phone number?
What is your email address?
What is your employment status?
What is your highest level of education?
What is your criminal history?
Have you ever been diagnosed with a mental illness?
Do you have a history of substance abuse?
Do you have a history of self-harm?
Do you have a history of suicide attempts?
Do you have a history of violence?
What are the current symptoms that you are experiencing?
What is your current level of functioning?
What is your current mental state?
What is your current level of insight?
What is your current level of judgment?
What is your current level of impulse control?
What are your current living arrangements?
Do you have any current support system in place?
What are your current treatment goals?