Get Biographical Information Form

Filling out the Biographical Information Form online is an essential step for a comprehensive understanding between you and your therapist. This guide provides clear, step-by-step instructions to help you complete each section accurately and effectively.

Follow the steps to successfully fill out your form.

1. Click ‘Get Form’ button to obtain the form and open it in a suitable editing tool.
2. In the 'NAME' field, enter your full name clearly. Complete your 'AGE' and 'SEX' in the respective fields. Next, provide the 'DATE' of filling out the form and your 'BIRTH DATE' along with 'BIRTH PLACE'.
3. Fill in 'SEXUAL ORIENTATION' to indicate your orientation. In the 'ADDRESS' section, provide your complete address including city and zip code.
4. Enter your contact numbers in the telephone section, noting phone numbers for routine messages and confidential/private messages distinctly.
5. Identify a person to contact in case of an emergency, providing their name and phone number.
6. In the 'REFERRAL SOURCE' section, state how you were referred to the therapist, if applicable.
7. Respond to the question 'WHY ARE YOU SEEKING THERAPY?' with as much specificity as you are comfortable with.
8. Indicate the severity of the stated problem by selecting one of the provided options: Mild, Moderate, Severe, or Very Severe.
9. Detail your 'EDUCATION HISTORY' by including your highest level of education achieved.
10. Outline your 'WORK HISTORY', including your current employer and occupation.
11. In the 'CURRENT HOUSEHOLD' section, provide details such as marital status, with whom you live, their names, years together, relationship, education, and occupation.
12. Document your 'RELATIONSHIP HISTORY' including years together and nature of relationships.
13. List any children, step-children, or grandchildren along with their names and ages, and summarize your relationship with them.
14. Provide information regarding parents and step-parents, detailing their names, ages, occupations, and your relationship with them.
15. List your siblings with their names, ages, and brief statements about your relationships.
16. Describe your childhood in general, discussing relationships with family members and any significant events.
17. If applicable, note your age at the time of your parents' divorce and explain how it affected you.
18. List traumatic events that have impacted you, elaborating as needed.
19. Discuss any family history of alcoholism, mental illness, or violence that may be relevant.
20. Indicate any significant illnesses in your family medical history.
21. Document healthcare providers you currently see or have seen, and provide details on any past or present medical problems.
22. In the medication section, specify the medications you are taking, including dosages and their purposes.
23. Provide details about any past or present substance use or abuse, including treatments.
24. If applicable, describe any thoughts of suicide or violent behavior along with circumstances.
25. List your current social support network, including friends and groups.
26. Share how you take care of yourself physically and emotionally.
27. Provide insights into your personal well-being, discussing your sleep patterns, eating habits, body image, and overall attitude.
28. Describe how you typically feel and behave around others.
29. Discuss your spirituality or religion, covering the identity at birth and current practices.
30. If you have a history of psychotherapy, document all relevant details such as beginning and ending dates, session estimates, therapists' information, and outcomes.
31. If you are involved in any current or pending litigation, describe the situation briefly.
32. Discuss what brings you joy or pleasure in life.
33. Share any major worries or fears you may have.
34. Elaborate on your important hopes or dreams.
35. Finally, provide any other information that you feel is important for your therapist to know.
36. Once finished, save your changes, and consider downloading, printing, or sharing your completed form.

Complete your Biographical Information Form online today for a smoother therapeutic process.