Intake Form & Questions

REQUIREMENTS:

Find a person to role play with. Have them choose a character to play. Answer the prompts to assist with the intake process and questions for your interview.

POSSIBLE

ACTUAL

In this section, briefly explain the person in the selected intake form you will use to conduct your mock interview (50 words):

10

Describe possible culture/subculture influences on the client (50-75 words):

10

Describe the presenting problem (30-40 words):

5

Explain the possible identified problems. (30-40 words):

5

Next, after reviewing the selected intake form, write 10 questions, based off the information presented in the selected intake form, for your client to answer.

20

TOTAL

50