Intake Assignment Form
As you become more familiar with the various forms of psychopathology, you will realize that collecting an accurate and specific history of a client's psychosocial profile is a key element that can assist in establishing a diagnosis.
In this assignment, complete the following:
• Develop an intake assessment form for your future clinical practice. The form should provide the necessary information for you to make a competent diagnosis.
• Your intake assessment form should be written as a three- to four-page questionnaire with questions to aid in gathering relevant information to do the following:
o Form diagnostic impressions
o Complete a differential diagnosis
• Your questionnaire should tap into key areas of developmental, social, emotional, medical, behavioral, psychological, and athletic performance functioning.
• Your intake assessment form should contain the following components:
o Identifying information
o Presenting problem
o Symptomatology
o Developmental history
o Educational history
o Family history
o Medical history
o Athletic/performance history
• Develop specific questions to obtain detailed information about these components. You are welcome to review intake assessment measures you have access to professionally, or you can conduct research to locate and view examples of intake assessment forms.
• The level of detail within these sections is up to your discretion as well as the inclusion of additional components (such as checklists or diagrams).
Format your assignment according to the following formatting requirements:
1. The answer should be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides.
2. The response also include a cover page containing the title of the assignment, the student's name, the course title, and the date. The cover page is not included in the required page length.
3. Also Include a reference page. The Citations and references should follow APA format. The reference page is not included in the required page length.