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Clinical Psychology Intake Interview Form

This intake interview form collects personal information from a student seeking counseling services. It asks questions about the student's previous counseling experiences, relationships with classmates and teachers, strengths and weaknesses, plans after high school, biggest problems, and who they would like to approach to discuss issues. The form is to be attached to the student's personal information sheet and includes spaces for notes from the values formator conducting the intake interview.

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Derick Conanan
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0% found this document useful (0 votes)
434 views1 page

Clinical Psychology Intake Interview Form

This intake interview form collects personal information from a student seeking counseling services. It asks questions about the student's previous counseling experiences, relationships with classmates and teachers, strengths and weaknesses, plans after high school, biggest problems, and who they would like to approach to discuss issues. The form is to be attached to the student's personal information sheet and includes spaces for notes from the values formator conducting the intake interview.

Uploaded by

Derick Conanan
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Intake Interview Form

INTAKE INTERVIEW FORM (to be attached to their Personal Information Sheet)

Name: ___________________________________________________________________________ Nickname: Technology:


Last Name Given Name Middle Name

1. Have you consulted a Psychiatrist/ Psychologist/ Counselor before? If yes, when? _________________________________________

2. How long and how many sessions?_______________________________________________________________________________________________

3. For what reason? __________________________________________________________________________________________________________________

4. What can you say about your classmates and teachers? _______________________________________________________

5. What are the subjects you like least? Why? _________________________________________________________________

6. What would you like to change at home and in your family? Why? ______________________________________________

___________________________________________________________________________________________________

7. Do you have friends here in school? At home? What do you usually do together? __________________________________

____________________________________________________________________________________________________

8. What are your strengths-talents, skills, interests, positive attitudes, etc.? _________________________________________

____________________________________________________________________________________________________

9. What do you think are your weaknesses – fear, difficulties, problems, negative attitudes etc.? ________________________

____________________________________________________________________________________________________

10. What are your plans after high school? What are you doing to achieve your plans? _________________________________

____________________________________________________________________________________________________

11. If you will be given a chance to correct one mistake you did in the past, what would that be? Why?____________________

____________________________________________________________________________________________________

12. What significant problems affect you the most that you would like to share? ______________________________________

____________________________________________________________________________________________________

13. Who would you like to approach to discuss your problem? Why? _______________________________________________

____________________________________________________________________________________________________

VALUES FORMATOR’S ASSESSMENT

___________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
Date of In-take Interview ________________________________________________
Values Formator Name & Signature _______________________________________
Note: All information stated above will be kept confidential. Page. 1

Common questions

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Identifying strengths and talents during an intake interview can contribute to personal development by boosting self-esteem, which enhances motivation and engagement in activities. It also aids in setting realistic goals aligned with one's capabilities, fostering a positive outlook towards personal achievement .

Exploration of disliked subjects in the intake interview reveals educational challenges by highlighting areas where the individual may struggle or lack interest. This information is crucial for identifying potential learning barriers, allowing for the development of support strategies that accommodate individual learning needs .

Sharing weaknesses and problems during an intake interview can lead to psychological benefits such as increased self-awareness, stress relief from verbalizing issues, and the initial steps towards behavioral change through acknowledgment. It also allows the interviewer to tailor support strategies effectively .

The intake interview assesses the individual's social support system by exploring relationships and interactions at school and home. Understanding these dynamics helps identify the availability of emotional and academic support, influencing the individual's overall well-being and ability to manage challenges .

The question about preferred problem-solving approaches provides insight into the individual's coping mechanisms and decision-making processes. Understanding these preferences allows counselors to devise personalized strategies that resonate with the individual's natural inclinations and strengths, enhancing the effectiveness of interventions .

Reflecting on a past mistake encourages learning from experiences, promoting personal growth by understanding the consequences of actions and developing strategies to avoid future errors. This reflection fosters maturity and resilience, crucial aspects of emotional and cognitive development .

The intake interview form explicitly states that all personal information provided during the session will be kept confidential. This assurance aims to encourage openness from individuals seeking help, knowing that their privacy is respected and safeguarded .

Discussing future plans during the intake interview can motivate students by clarifying their aspirations and linking current education to long-term goals. It encourages proactive behavior in pursuing necessary steps, such as skill development and academic improvement, enhancing commitment to their educational journey .

Insights into family dynamics and desired changes provide a values formator with context regarding the individual's environment and influences. Understanding these elements helps in formulating strategies that address external stressors and enhance the support system at home, which is crucial for holistic development .

The intake interview plays a critical role in establishing an effective counselor-client relationship by building trust through confidentiality assurances and active listening. It also sets the foundation for understanding the client comprehensively, which fosters a tailored and empathetic approach to addressing their concerns .

INTAKE INTERVIEW FORM (to be attached to their Personal Information Sheet)
Name: ____________________________________________

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