Assessment
Start Date
Name
DOB
Age
Address
Telephone Numbers
Email
GP Address
Medication
Current Mental State
Personal and Social Relationships, current.
Relationship History
Sexuality and Gender Issues
Sexual History
Background History
Religious Beliefs
Housing Situation
Financial Situation
Occupation
Previous Experience of Therapy
Hopes and Fears for the Future
Aims and Objectives for Therapy
Substance Use Issues
Physical Health Issues
Suicidality,DSH, Risk History and Current Risk
(Self and Others)
Date
Signed