Get Biopsychosocial Screening Form 2020-2025

The Biopsychosocial Screening Form is a comprehensive tool designed to assess an individual's mental, emotional, and social well-being. This guide provides step-by-step instructions on how to complete the form online, ensuring that you provide the necessary information accurately and efficiently.

Follow the steps to complete the form easily and accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your selected online platform.
2. Begin by providing your identifying information. Fill in your name, address, city, state, telephone numbers, and preferred method for contact, including your availability and referral source.
3. Proceed to the race/ethnicity section and select your appropriate classification from the provided list.
4. Indicate your marital status by selecting from the options provided, specifying details such as the year of marriage or separation if applicable.
5. In the prior treatment/counseling history section, answer the questions related to past counseling experiences and hospitalizations, providing details as necessary.
6. Complete the family history portion by noting any relevant illness in family members and whether they reside with you.
7. For the legal history section, indicate if you have any current or past legal issues and provide additional details as required.
8. In the military history section, state whether you have served in the military and provide details regarding your discharge and branch of service.
9. Fill out your educational history, including your highest grade completed and any special educational circumstances.
10. Complete the education and learning screening by answering questions about your learning abilities and any barriers you may face.
11. In the leisure/recreational history section, describe your interests and whether your activity level has changed recently.
12. Continue to the employment/vocational history, indicating your current employment status and providing details of your employment history over the last five years.
13. If applicable, discuss how financial issues may affect your current conditions and treatment.
14. Provide information regarding your health assessment, medication, allergies, and physician contact details.
15. Complete the medical hospitalizations section, listing any past hospitalizations and their outcomes.
16. In the physical functioning screening, describe any limitations you may have, alongside the physical pain screening that follows.
17. Detail any behavioral traits you have experienced in the respective section by checking appropriate boxes.
18. Finally, provide any additional notes that are pertinent and sign the document. Make sure to include the date.
19. Once all sections are complete, save your changes, download the form for your records, print it for submission, or share it as needed.

Complete your Biopsychosocial Screening Form online today and take a step towards understanding your mental and emotional health.