The Counselling Assessment Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring both editable and printable versions for your convenience.
Counselling Assessment Form Template UK Editable – PrintableSample
Counselling Assessment Form Template UK 1. Client Information 2. Referral Source 3. Reason for Counselling 4. Psychological History 5. Current Mental Health Status 6. Support System 7. Goals for Counselling 8. Consent and Confidentiality 9. Emergency Contact Information 10. Client Declaration
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WORD
Examples
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Name of Referrer]
[Referrer’s Contact Information]
This assessment form is designed to gather relevant information regarding the client’s background, presenting issues, and goals for counselling. The information provided will assist the counselling process and ensure effective support.
Date of Birth: [DD/MM/YYYY]
Gender: [Male/Female/Other]
Ethnicity: [Specify]
Occupation: [Specify]
Emergency Contact: [Name and Phone Number]
Please describe the main challenges or issues you are currently facing: [Detailed description].
Provide a brief history of your mental health and any previous counselling or therapeutic interventions: [Detailed history].
What are your goals for counselling? What changes would you like to see in your life? [Goal description].
Do you have any current thoughts of self-harm or suicide? [Yes/No]
If yes, please elaborate: [Details].
[Signature of the Client]
[Name of the Client]
[Name of the Client]
[Client’s ID]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Name of Referrer]
[Referrer’s Contact Information]
This form is intended to collect essential insights about the client’s background, presenting concerns, and counselling aspirations, ensuring a tailored approach to support.
Date of Birth: [DD/MM/YYYY]
Gender: [Male/Female/Other]
Ethnicity: [Specify]
Occupation: [Specify]
Emergency Contact: [Name and Phone Number]
What brings you to counselling? Please provide a detailed description: [Detailed description].
Please outline any previous mental health conditions, treatments, or interventions: [History].
What specific outcomes do you hope to achieve through counselling? [Outcomes description].
Are there any current risks to your safety or well-being? [Yes/No]
If yes, please provide details: [Details].
[Signature of the Client]
[Name of the Client]
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