Intake questionnaire


Intake questionnaire may be administered orally or given in pen and paper format. Clinician is encouraged to allow the client to explain or elaborate on their responses if the client feels the need.

Target Populations:

Functioning age of 12 and up, though portions of the questionnaire may be administered to younger population with the professional discretion of the clinician.

Expected Results and Troubleshooting:

The expected results are that the client will provide information that can be used to assess strengths and goals in a manner that engages the client and attempts to build rapport by involving a client's interests and passions.

Expected troubleshooting could include a client who's impairment interferes with their communication abilities or a client that is hesitant to share. The purpose of this questionnaire is to meet a client where they are at, as such clinicians are encouraged to be flexible, encouraging, and for clinicians to be ready to adapt to the communication styles of their clients.

Related Sources:

Moyers, T. B. (2014). The relationship in motivational interviewing. Psychotherapy, 51(3), 358-363. doi:10.1037/a0036910