On a hospital patient intake form, examples of standard questions about mental health include what has led the patient to seek treatment at this time, the history of mental health disorders or chemical dependency in the patent's family, current use of alcohol and other drugs, and any prescriptions or over-the-counter medications the patient is taking, according to Fairview Counseling Centers. Mental health intake forms also ask patients if they have thought about death or hurting themselves or other people.
Hospital intake forms for mental health patients also contain questions about patients' social history, including marital status, living situation, employment status, race and ethnicity, and level of educational attainment, explains Fairview Counseling Centers. There may also be questions about people's childhoods, their relationships with their family members and their current assessment of the quality of their social support system. Patients are also asked if they have had any legal issues and, if yes, to describe them.
To assess people's safety, mental health intake forms also ask patients if they have thought about hurting themselves, if they have tried to hurt themselves, if they have harmed other people or property, and if they have access to firearms in their place of residence, states Fairview Counseling Centers.