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Comprehensive History Taking Form

The document is a History Taking Form designed to gather comprehensive personal, family, educational, and psychological information from clients. It includes sections on personal questions, early life and development, family dynamics, educational history, future goals, and psychological aspects. This structured format aims to facilitate a thorough assessment of the client's background and mental health status.

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Ayesha Sultan
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7 views2 pages

Comprehensive History Taking Form

The document is a History Taking Form designed to gather comprehensive personal, family, educational, and psychological information from clients. It includes sections on personal questions, early life and development, family dynamics, educational history, future goals, and psychological aspects. This structured format aims to facilitate a thorough assessment of the client's background and mental health status.

Uploaded by

Ayesha Sultan
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

History Taking Form

Client’s Name: Number of Sessions:


Age: Date of Session:
Gender: Time of Assessment:

Personal Questions
 What is your name?
 How old are you?
 Where are you from?
 What is your religion?
 What is your nationality?
 Are you happy with your life?
 What hobbies or activities do you enjoy in your free time?

Early Life & Development


 Was your birth normal or were there any complications?
 Did you reach all developmental milestones on time during childhood?
 Have you ever faced any kind of physical/medical or mental health issue?

Family Questions
 How many brothers and sisters do you have, and what is your position among them?
 What is your father's name?
 What is your father's age?
 What does your father do for work?
 What is your father's temperament like?
 What kind of relationship do you have with your father?
 What is your mother's name?
 What is your mother’s age?
 What does your mother do for work?
 What is your mother’s temperament like?
 What kind of relationship do you have with your mother?
 What is the educational background of your parents?
 Who is the most pampered among the siblings?
 If someone else is favored, do you have any problem with it?
 What is your relationship like with your siblings?
 What things do you share with them?
 Do you live with your family or separately?
 What is the environment like at your home?

Educational History
 What is your level of education or how much have you studied?
 What was your favorite subject?
 How has your academic record been?
 What kind of student were you?
 What was your relationship like with your teachers?

Future Goals Inquiry


 What do you want to become in the future?
 What qualities would you like to improve in yourself?
 Are you satisfied with your current life, or do you wish to improve something?

Psychological Aspects - Neurotic Symptoms


 Do you often feel anxious or worried? Why?
 Do you have sleep issues?
 Do you frequently feel sadness or hopelessness?
 Do small things bother you a lot?
 Do you find it difficult to manage daily tasks?

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