Adult health screening intake form

I understand that the purpose, potential risks and benefits, and alternatives to any treatment, as well as the risks of not having treatment, will be explained to me upon my request, and that I can always decline treatment. I understand that while my treatment will be designed to help me, there is no guarantee of a successful outcome. Psychotherapy involves risks, such as but not limited to, the development or worsening of emotions such as anxiety, sadness and anger. I understand that this is a normal response to working through life experiences and that these reactions should be discussed with my therapist or physician. Treatment with Medication also has certain risks, varying with the type of medication prescribed, which will be explained to me.
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Health Assessments in Primary Care

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Preventive Care Checklist Form©

Despite the high prevalence of mental health and substance use problems, too many Americans go without treatment — in part because their disorders go undiagnosed. Regular screenings in primary care and other healthcare settings enables earlier identification of mental health and substance use disorders, which translates into earlier care. Screenings should be provided to people of all ages, even the young and the elderly. The Healthy Living Questionnaire Please note that the first 8 questions are taken from the SF-8 Health Outcomes Questionnaire, and require a license to be administered. Patient Stress Questionnaire is a tool used in primary care settings to screen for behavioral health symptoms. The Patient Satisfaction Survey, based upon the review of integration literature and input from demonstration site representatives, is a general satisfaction survey developed to improve consumer satisfaction with services and the model, as well as comfort levels with treatment and treatment setting.
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Assessment Forms

Language: English French. Preventive care is a cornerstone in the practice of family medicine, but is often difficult to provide because of a lack of time and logistic difficulties. To develop an evidence-based practice-relevant preventive care checklist form to be used by family physicians during complete health assessment of adults. Guidelines for preventive health care of adults at average risk from the Canadian Task Force on Preventive Health Care and from other Canadian sources where the Task Force guidelines were not up-to-date were reviewed.
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This list of brief health assessment questions is organized by behavior or risk and sorted alphabetically. The topic headings are provided for your convenience, but may not be appropriate for patients to see. Select questions that are appropriate for your patient population. Reformat the questions as needed to fit with your practice flow or information systems.
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