Get Adult Initial Assessment - Stephen Mardell, Mft

The Adult Initial Assessment - Stephen Mardell, MFT is a critical document designed to help you share important personal and medical information. Completing it accurately online ensures confidentiality and helps streamline the therapeutic process.

Follow the steps to fill out the form online for your initial assessment.

1. Press the ‘Get Form’ button to acquire the Adult Initial Assessment form and open it in your preferred online editor.
2. Begin by entering your name in the designated field at the top of the form. Indicate your gender by marking 'M' or 'F' as applicable.
3. Fill in the date of the assessment, your date of birth, and your place of birth, alongside your age.
4. Provide your complete address including city and ZIP code, and your social security number, email, and telephone numbers.
5. Detail your current occupation and employer information; include the name and address of your employer.
6. List an emergency contact with their phone number for any urgent situations.
7. Record your medical doctor’s name and phone number, as well as the source of your referral to Stephen Mardell, MFT.
8. Answer whether you would like the referral source to be informed of your consultation.
9. Indicate your highest level of education and specify the type of degree obtained.
10. Describe your presenting problem as specifically as possible, including when it started and how it affects you.
11. Fill in your current marital status and, if applicable, details about your partner, including their name and how long you have been together.
12. List your past and present marriages, along with names and statements regarding the nature of each relationship.
13. Provide information about your children, stepchildren, or grandchildren including their names, ages, and relationships.
14. Detail information about your parents and step-parents including names, ages, occupations, and relationships with them.
15. If applicable, indicate your age when your parents divorced and how that affected you.
16. Fill in information about your siblings, noting any deceased siblings and the circumstances.
17. Provide a general description of your childhood experiences, including relationships and any relevant issues.
18. Complete the family medical and psychiatric history section, describing any relevant illnesses in your family.
19. Specify any history of alcohol or drug problems in your family.
20. Provide details about any past or present psychotherapy experiences.
21. Fill in your past and present medical care information, noting any major medical issues.
22. Provide information on any drugs you are currently prescribed, including type, amount, frequency, and last date used.
23. Address any past or present drug and alcohol use or abuse, including recovery programs if applicable.
24. Describe any history of suicide attempts or violent behavior.
25. Detail your friendships, community involvement, and spirituality.
26. Indicate the effects of specific symptoms or problems on your life.
27. Rate how these problems affect different areas of your functioning.
28. Describe what brings you joy, your main worries, your strengths and weaknesses, and your goals for treatment.
29. Lastly, use the space provided to add any additional information you wish to share.
30. Once you have completed the form, review all the information for accuracy before saving your changes, downloading, printing, or sharing the assessment.

Complete your Adult Initial Assessment online today to take a step towards improved mental health.