Mental Health Screening Form - Behavioral Health Assessment
Mental Health Screening Form - Behavioral Health Assessment
A mental health screening form for therapists and clinicians to assess patients for depression, anxiety, stress levels, and general psychological well-being.
Full Name *
Your answer
Date of Birth *
Your answer
Phone Number *
Your answer
Today's Date *
Your answer
Have you previously received mental health treatment or counseling?
Yes, currently receiving
Yes, in the past
No, never
Over the past two weeks, how often have you felt little interest or pleasure in doing things?
Not at all
Several days
More than half the days
Nearly every day
Over the past two weeks, how often have you felt down, depressed, or hopeless?
Not at all
Several days
More than half the days
Nearly every day
Over the past two weeks, how often have you had trouble falling or staying asleep, or sleeping too much?
Not at all
Several days
More than half the days
Nearly every day
+ 13 more questions
About this template
A mental health screening form for therapists and clinicians to assess patients for depression, anxiety, stress levels, and general psychological well-being.
How does it work?
Click Use template. We'll drop a copy into your Formswrite workspace - no setup needed.
Tweak the questions, branding, and logic to fit your workflow. Add your logo, colors, and cover image.
Publish and share the link, embed it on your site, or drop it into a chatbot widget. Responses stream straight to your dashboard.