Bio-Psychosocial-Spiritual Assessment

Client Name: Today’s Date:

Preferred Pronouns: Client DOB:
Referred By:
I am interested to know what is most important and meaningful in your life that might be
relevant to our work together. Please feel free to answer (or not!) the questions in any way.
What is your current living situation and are you satisfied with it?
Do you work? If so, what do you do and do you enjoy it?
How did you get to this appointment today and do you have reliable transportation?
Are your finances a concern right now?
Do you have any children or other dependents living with you?
Have you ever been treated for any major medical problems?
Have you ever been diagnosed and/or treated for a mental illness before?
Do you have a family history of any medical or psychiatric problems?
Are you currently taking any medications? If so, what are they?
Are you currently using any substances aside from your prescribed medications?
Have you ever been to therapy before? If yes, when was the last time you went?
When you are going through hard things, what are sources of strength that help you to cope?
Do you have family, friends, or others that you can rely on?
Are you satisfied/ happy with your social life?
What currently brings your life a sense of meaning and peace?
Is spirituality and/or a religious practice important in your life?
If yes, how? If no, has it had a negative impact on your life?
Are you a member of a religious or spiritual group? How do you feel about the sense of
community it provides?
Are there any specific spiritual or religious beliefs or practices you use to help you cope during
hard times?
Are you interested in incorporating your spiritual and/or religious beliefs into the work we do
together?