A Psychiatric Evaluation Form is the structured intake document a psychiatrist or mental health clinician uses to gather a new patient's presenting concerns, psychiatric and medical history, medications, and mental status before making a diagnosis and treatment plan. Psychiatrists, psychiatric nurse practitioners, and behavioral health clinics use it to standardize the initial assessment. This template is a starting point, so confirm wording with your own compliance or legal counsel.
What does a Psychiatric Evaluation Form include?
The American Psychiatric Association's practice guidelines describe the domains a comprehensive initial evaluation should cover. Most forms collect the following sections.
- Chief complaint and presenting problem. The patient's reason for the visit and history of the present illness, including onset, duration, and severity of symptoms.
- Psychiatric history. Prior diagnoses, hospitalizations, therapy, past medications, and any history of suicide attempts or self-harm.
- Current medications and allergies. Psychiatric and non-psychiatric medications, dosages, supplements, and known drug allergies or reactions.
- Medical and family history. Relevant medical conditions and a family history of psychiatric or substance use disorders.
- Substance use. Use of alcohol, tobacco, cannabis, and other substances, including frequency, quantity, and history of treatment.
- Social and developmental history. Living situation, relationships, employment, education, trauma, and other psychosocial stressors.
- Mental status examination. Clinician observations of appearance, mood, affect, thought process, cognition, insight, and judgment.
- Risk assessment. Screening for suicidal or homicidal ideation and current safety concerns that require immediate attention.
- Assessment and plan. The clinician's diagnostic impression and initial treatment recommendations, including medications and follow-up.
How to administer the Psychiatric Evaluation Form
- Send it before the appointment. Share the form by secure link so the patient can complete the history sections at home.
- Have the patient complete the history. Presenting concerns, medications, and social history are patient-reported, which saves interview time.
- Reserve clinical sections for the clinician. The mental status exam, risk assessment, and diagnosis are completed by the evaluating provider.
- Capture a signature. Collect the patient's e-signature to acknowledge the information is accurate and complete.
- Store it securely. Keep the completed form in encrypted, HIPAA-compliant storage so it is ready before the visit.
- Update for returning patients. Resend the form periodically so medications, symptoms, and stressors stay current between visits.
Who uses the Psychiatric Evaluation Form?
- Psychiatrists. For initial diagnostic assessments and medication management planning.
- Psychiatric nurse practitioners and PAs. To conduct evaluations and prescribe within their scope of practice.
- Behavioral health and community clinics. To standardize intake across a team of mental health providers.
- Telepsychiatry practices. To gather history in advance of a remote evaluation.
Digital vs paper Psychiatric Evaluation Form
| Paper | Zentake digital |
|---|---|
| Handwriting can be illegible or incomplete | Required fields improve accuracy and legibility |
| Filled out in the waiting room, delaying the visit | Completed at home before the appointment |
| Signed with pen on paper | Captures a legally valid e-signature |
| Stored in a filing cabinet | Stored in encrypted, HIPAA-compliant systems |
| Re-printed and re-keyed for each update | Resent and updated in a few clicks |
| Staff manually sort and file each form | Less staff handling and no manual filing |
How Zentake helps with the Psychiatric Evaluation Form
- Custom form builder. Build your evaluation with the custom form builder to match your clinic's intake sections and scales.
- E-signatures. Collect a valid electronic signature so patients can attest to their history remotely.
- Before the visit. Forms are ready before the visit, which helps mental health practices start the appointment focused on the patient.
- In-clinic tablets. Patients who arrive without completing the form can finish it on an in-clinic tablet.
- HIPAA compliant. Every submission is encrypted, and a signed BAA is included on every plan.
References
The domains reflected in this template are based on the American Psychiatric Association's Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition, which describe the history, mental status examination, and risk assessment expected in a comprehensive initial evaluation. Requirements and documentation standards vary by state and payer, so confirm your form with your own clinical and compliance leadership.
Last updated: August 2026