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Case Conceptualisation Form Template

Streamline Your Client Assessments and Develop Effective Solutions

Struggling to create a clear picture of your client's needs? This case conceptualisation form template helps mental health professionals like you outline client challenges through a structured biopsychosocial approach. With this template, you can efficiently assess, document, and strategize treatment plans, enhance communication with clients, and ensure a comprehensive and compliant evaluation. Experience a more organized way to formulate cases-try the live template today to ease your workflow.

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Client full name
Client ID or medical record number (MRN)
Date of conceptualisation
Clinician full name
Service setting
Please Specify:
Referral source
Self
Family
Primary care
Specialist
School
Court or legal
Employer
Unknown
Other
Please Specify:
Chief concern in the client's words
Primary domains affected
Please Specify:
Onset and course
Acute (under 1 month)
Subacute (1-6 months)
Chronic (over 6 months)
Recurrent or episodic
Unknown or not sure
Client-stated goals
Functional impact
None
Mild
Moderate
Severe
Extreme or unable to function
Unknown or not assessed
Current risk to self (suicidal ideation or intent)
Yes
No
Current risk to others (homicidal or violent ideation or intent)
Yes
No
Brief details of current risk and protective considerations
Safeguarding actions taken
Safety plan created
Crisis resources provided
Means restriction discussed
Contacted emergency services
Notified supervisor or team
Notified guardian or caregiver
Referral to higher level of care
None
Other
Please Specify:
Psychiatric history
Previous diagnoses
Prior psychotherapy
Psychiatric hospitalisation
Suicide attempts
Self-harm
Family psychiatric history
None reported
Other
Please Specify:
Brief details of psychiatric history
Medical history and current medications
Substance use status
None
Occasional use without problems
Use with concerns
Dependence or addiction
Unknown or not assessed
Brief details of trauma history or exposure
Context and cultural considerations
Trauma or adverse experiences disclosed
Yes
No
Prefer not to say
Unknown or not assessed
Predisposing factors
Precipitating factors
Perpetuating factors
Protective strengths and resources
Diagnostic impression (working and differential)
Case formulation hypothesis
Planned interventions
Please Specify:
Session frequency
Multiple times per week
Weekly
Every 2 weeks
Monthly
As needed
To be determined
Measurable treatment objectives
Next review date
Anticipated barriers to care
Please Specify:
Collateral contacts involved
Primary care clinician
Psychiatrist
Therapist
School counselor
Case worker
Family or guardian
Legal representative
None
Other
Please Specify:
Patient consent discussed and documented
Yes
No
Type your full name as signature
Date of attestation
I confirm this conceptualisation reflects current information to the best of my knowledge
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration related to case conceptualisation form template and FormCreatorAI article

When to use this form

Use this structured form during intake, treatment planning, and supervision when you need a clear map of a client's difficulties and drivers. It suits therapists, counselors, and trainees working with anxiety, mood issues, grief, or complex presentations. Capture the 5 Ps (presenting, predisposing, precipitating, perpetuating, and protective factors) to align goals and guide interventions. Pair it with the Mental health assessment form to establish baseline symptoms, or the Grief assessment form when bereavement is central. For ongoing monitoring, invite clients to log patterns with a Mental health journal form. In brief case conferences, the structure helps your team agree on priorities and next steps.

Must Ask Case Conceptualisation Questions

  1. What are the main problems right now, and what outcomes do you want?

    This establishes the presenting issues and desired change, so you target what matters most. It also sets measurable goals, which improves engagement and treatment planning.

  2. What personal or family history might have set the stage?

    Exploring vulnerabilities (earlier trauma, health conditions, family patterns) clarifies why the problem developed. It prevents overfocusing on the present while missing long-term contributors.

  3. What recent events or triggers started or worsened the problems?

    Identifying recent triggers reveals timing, context, and precipitating stressors. You can then reduce exposure, plan coping, or address the source directly.

  4. What patterns, situations, or beliefs keep the problems going?

    Mapping maintaining cycles (avoidance, rumination, substance use, relationship loops) shows where to intervene. When you need objective tracking, pair this with the Saringan minda sihat (dass-21) form to gauge symptom severity and change.

  5. What strengths, supports, and resources can you draw on?

    Documenting strengths, supports, and values highlights protective factors you can amplify. It also informs relapse prevention and crisis plans.

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