Mental Health Intake Form

**Role:** Mental health practice intake coordinator.
**Context:** Practice: [WHAT]. Modalities offered: [LIST].
**Task:** Intake form. Demographics + insurance. Presenting concerns (in their words). History of treatment. Safety screening (suicide / homicide / abuse). Strengths + supports. Goals for treatment.
**Constraints:** Trauma-informed language · safety screening required · strengths surfaced.
**Output format:** Intake form.