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Psychological Report Format

This confidential psychological report summarizes the evaluation of a client. It includes their demographic information, the reasons for their referral, sources of information like interviews and psychological tests administered, observations of their background and behavior, test results without interpretation, an integration of findings, a diagnosis, and recommendations. Appendices with supporting documents like consent forms and test results are also listed. The purpose is to evaluate, guide, and understand the client's psychological profile to benefit their well-being.

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Rozeilda Abear
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363 views5 pages

Psychological Report Format

This confidential psychological report summarizes the evaluation of a client. It includes their demographic information, the reasons for their referral, sources of information like interviews and psychological tests administered, observations of their background and behavior, test results without interpretation, an integration of findings, a diagnosis, and recommendations. Appendices with supporting documents like consent forms and test results are also listed. The purpose is to evaluate, guide, and understand the client's psychological profile to benefit their well-being.

Uploaded by

Rozeilda Abear
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Introduction: Presents the document's title, preparer, and date of preparation.
  • Psychological Report: Contains demographic profile details outlining personal information collected for the psychological assessment.
  • Integration of Findings: Integrates gathered information to draw conclusions and identify significant patterns or issues.
  • Appendices: Lists documents relevant to the evaluation such as consent forms and detailed test result documents.

School of Health and Allied Sciences College

of Pre-medicine Department of
Psychology

CONFIDENTIAL PSYCHOLOGICAL REPORT


(for educational and quality training purposes only)

Prepared by:

Michael Dave J. Clarion, RPm

September 24, 2019


PSYCHOLOGICAL REPORT

Confidential Material
(for educational and quality training purposes only)

I. Demographic Profile

Name:
Birthdate:
Age:
Civil Status:
Program and Year:
Father’s Name:
Mother’s Name:

Admission Date: the date that the guidance office referred the client
Dates of Evaluation: the dates when did you conduct the tests and interviews Date
of Report: the date that you submitted the repot

II. Reasons for Referral

As an assessors, this helps to regulate and determine the clients emotional, psychological, and
well-being in the means of engaging the client’s welfare to join tasks as to evaluate, guide, assess,
and be able to be aware in order to understand the proper interpretation of his psychological
profile and benefit of his well-being.

III. Sources of Information


A. Interview with (client’s Name), (date)
B. Interview with the Guidance Counselor, (date)
C. Interview with the Parents/Guardians, (date)
D. Interview with Friends, (date)
E. Psychological Testing:
1. MBTI, (date)
Write short description about what is the tool all about and as to how this it
is being used in the assessment process

2. Beck Depression Inventory, (date)


Write short description about what is the tool all about and as to how this it
is being used in the assessment process
3. Meaning of Life (date)
Write short description about what is the tool all about and as to how this
it is being used in the assessment process

IV. Background and Behavioral Observations

A. Family History
What was the history of the client in terms of this category? Take note on
non-verbal cues and how your client behave during the interview.

B. Childhood

C. Educational History

D. Adolescent

E. Medical History

F. Interview with Corroborative Sources


1. Guidance Counselor
2. Parents/Guardian
3. Friend/Sister/Brother

V. Test Results

A. MBTI

Write short description about what is the table all about. Just present and
describe what the result is. Don’t interpret yet. The actual results of the client
should be placed under appendices

B. Beck Depression Inventory


Write short description about what is the table all about. Just present and
describe what the result is. Don’t interpret yet. The actual results of the client
should be placed under appendices

C. Meaning of Life

Write short description about what is the table all about. Just present and
describe what the result is. Don’t interpret yet. The actual results of the client
should be placed under appendices

VI. Integration of Findings


Based on the correlation of results from interview (psychosocial history) and test
administered, what are the red flags of your client? What conclusion can be drawn?
You may present the summary here

VII. Diagnosis
Based on your interpretation, what are the potential main problems and subproblems
of your client?

VIII. Recommendation
Will base on your treatment plan and progress map if there are progresses or not.

___________________ Date: _______________


School of Health and Allied Sciences College
of Pre-medicine Department of
Psychology

LIST OF APPENDICES

Informed Consent
Comprehensive In-Take Interview Form Test
Results:
MBTI
Beck Depression Inventory
HTP
Life Satisfaction Scale
Treatment Plan
Progress Map

School of Health and Allied Sciences College of Pre-medicine Department of Psychology CONFIDENTIAL PSYCHOLOGICAL RE
PSYCHOLOGICAL REPORT Confidential Material (for educational and quality training purposes only) I. Demographic Profile Name:
3. Meaning of Life (date) Write short description about what is the tool all about and as to how this it is being used in th
Write short description about what is the table all about. Just present and describe what the result is. Don’t interpret yet.
School of Health and Allied Sciences College of Pre-medicine Department of Psychology LIST OF APPENDICES Informed C

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