Free Mental Health Assessment Form

Please take a moment to share how you're feeling by filling out this form.
Date
Name
Gender
Male
Female
Phone Number
Have you experienced the following in the past two weeks?
Select all that apply:
Feeling down
Depressed
Hopeless
Anxious
Trouble sleeping/Sleeping too much
Thoughts of self-harm
Difficulty concentrating on tasks
Changes in appetite
Do you feel overwhelmed by stress?
On a scale of 1 to 10, how would you rate your overall mental health?
Do you have a support system you can turn to when needed?
Are there any specific concerns or issues you'd like to share?
Assessment Form Templates @ Template.net
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Thank you for completing this assessment!
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Support thorough mental health evaluations in just a few clicks using this Mental Health Assessment Form Template only provided by Template.net! This customizable resource is tailored to address diverse patient needs. Its editable fields simplify documentation. Leverage the AI Editor Tool for quick and precise updates, ensuring healthcare providers maintain accurate and accessible patient records!