Psychologist Template

Initial Intake Appointment (Psych)

A professional Psychologist template for healthcare professionals.

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Specialty

Psychologist

Used

382 times

Type

Note

Last edited

8/5/2026

Created by

Keilan Grey

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About this template

The Initial Intake Appointment (Psych) template is designed for psychologists conducting comprehensive assessments during a patient's first visit. This template helps clinicians document presenting problems, current functioning, history, risk assessment, mental state exam, and treatment plans. It is ideal for capturing detailed information necessary for formulating a diagnosis and developing a personalized treatment plan. This template is particularly useful for psychologists aiming to create thorough initial intake notes, ensuring all relevant aspects of a patient's mental health are considered.

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Clinical Interview: Presenting problem(s): - Anxiety and panic attacks - Difficulty concentrating at work Current functioning: - Mood: Anxious and irritable - Sleep patterns: Difficulty falling asleep, frequent awakenings - Employment status: Employed as a software engineer - Family dynamics: Supportive spouse, no children - Social interactions: Limited social interactions, prefers solitude - Exercise routines: Occasional jogging - Eating habits: Skips meals, low appetite - Energy levels: Low energy, especially in the afternoons - Hobbies: Enjoys reading and playing video games History: - History of Presenting Problem(s): Onset 6 months ago, worsening over time - Previous psychological assessments: None - Psychiatric history: No previous diagnoses - Personal and family medical history: Father with history of depression - Substance use: Occasional alcohol use - Family history: Father with depression, no other known mental health issues - Developmental milestones: Normal - Cultural factors: None relevant - Forensic history: None Risk Assessment: - History of self-harm: None - Addictive behaviours: None - Risk-taking behaviors: None Mental State Exam: - Appearance: Well-groomed, casual attire - Behaviour: Cooperative, but fidgety - Speech patterns: Normal rate and volume - Mood: Anxious - Affect: Restricted - Thought process: Logical and coherent - Orientation: Oriented to time and place - Memory function: Intact - Concentration levels: Impaired - Judgement: Intact - Insight: Good Formal Psychometric Assessments: - Beck Anxiety Inventory: Moderate anxiety Clinical Formulation: - Predisposing factors: Family history of depression - Precipitating factors: Increased workload - Perpetuating factors: Lack of social support - Protective factors: Supportive spouse Treatment Plan: 1. Generalized Anxiety Disorder (DSM-V-TR): - Goals: Reduce anxiety symptoms, improve sleep - Progress measurement: Weekly self-reports, monthly assessments 2. Secondary Diagnosis: None Additional notes: - Patient is motivated to engage in therapy and explore coping strategies.