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  • Initial Diagnostic Interview

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    Mitchell Stroicz
    11 views3 pages
    Template for questions/information gathering in an initial psychological session

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    Template for questions/information gathering in an initial psychological session

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views3 pages

    Initial Diagnostic Interview

    Uploaded by

    Mitchell Stroicz
    Template for questions/information gathering in an initial psychological session

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    Initial Diagnostic Interview

    Client Name:

    DOB:

    Presenting Problem

    History of Presenting Problem

    Past Treatment

    Medical History

    Education and Employment

    Substance Usage

    Tobacco

    Alcohol
    Caffeinated Drinks

    Illicit

    Benzodiazepines

    Systemic Enquiry (Physical)

    Sleep

    Energy

    Appetite

    Weight

    Mood

    Memory

    Concentration

    Libido

    Family Psychiatric History

    Mental State Examination

    Assessment Outcomes

    Diagnostic Formulation
    Provisional Diagnosis

    Differential Diagnosis

    Treatment Plan

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