Mental Health Intake Form

Prompt

**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.

How to use this prompt

1. 1

   Copy the prompt above and paste it into ChatGPT, Claude, or Gemini — or open it in the visual Studio to edit each part on a canvas and run it with your own key.

2. 2

   Replace any bracketed placeholders with your specifics. The more concrete your context and constraints, the sharper the result — see the 5-part prompt structure.

3. 3

   Run it, then refine. Ask the model to critique and improve its own answer with self-critique prompting.

Techniques in this prompt

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