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Psychiatrist Interview Form Template

Streamline Your Patient Interviews for Better Outcomes

Conducting thorough patient interviews can be challenging, especially under time constraints. This psychiatrist interview form template is designed specifically for mental health professionals seeking to optimize their interviewing process. By utilizing this template, you can easily gather crucial patient information, enhance communication, and improve assessment accuracy while ensuring compliance with data protection standards. Enjoy the benefits of easier data collection, organized patient insights, and improved preparation for follow-up sessions. Experience a simplified way to conduct interviews by using the live template today.

Full name
Email address
Mobile phone number
Current city and state
Are you legally authorized to work in the country of employment?
Yes
No
Will you now or in the future require visa sponsorship?
Yes
No
Highest medical degree
MD
DO
International equivalent
Other
Please Specify:
Board status in Psychiatry
Board certified
Board eligible
Neither
State(s) currently licensed to practice psychiatry
DEA registration is active
Yes
No
NPI number
If applicable, provide brief details on claims or actions
Any malpractice claims or disciplinary actions in the past 5 years?
None
1
2 or more
Prefer not to say
Years of independent psychiatric practice
<1
1-3
4-7
8-15
16+
Patient populations you are comfortable treating
Adults
Children and adolescents
Geriatric
Perinatal
LGBTQ+
Veterans
All ages
Other
Please Specify:
Conditions you most commonly manage
Please Specify:
Treatment modalities you provide
Please Specify:
Care settings you have experience in
Please Specify:
Comfortable supervising residents or advanced practice clinicians
Yes
No
Desired employment type
Full-time
Part-time
Locum tenens
Per diem
Telepsychiatry only
Hybrid
On-site only
Earliest available start date
Typical weekly availability
Weekdays
Evenings
Weekends
Nights
Flexible
Willing to take call
Yes
No
Not applicable
Clinical scenarios you are comfortable with
Desired pay range (amount and basis)
Expected compensation model
Salary
Hourly
Per-visit
RVU-based
Not sure/Discuss
EMR systems you have used
Epic
Cerner
Athenahealth
eClinicalWorks
NextGen
DrChrono
None
Other
Please Specify:
Comfort with telepsychiatry tools
Very difficult
Difficult
Neutral
Easy
Very easy
Languages you can provide care in
Please Specify:
Briefly describe your approach to medication management and shared decision-making
Share a challenging case and your clinical decision-making process (de-identify details)
How do you coordinate care with therapists, primary care, and interdisciplinary teams?
How do you incorporate cultural humility and trauma-informed care into practice?
Reference 1 full name
Reference 1 email
Reference 1 phone
Reference 2 full name
Reference 2 email
Reference 2 phone
I consent to a background check if required for employment
Yes
No
Signature
Date
I attest that the information provided is true and complete to the best of my knowledge
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration depicting a psychiatrist interview form template layout and design elements.

When to use this form

Use this interview form before or during a first visit, a medication review, or a telehealth check-in to capture a clear history, current symptoms, risks, and goals. It helps you structure the conversation, reduce missed details, and document a focused plan. Clinicians, trainees, and care coordinators benefit, especially in busy outpatient clinics and crisis consults where time is tight. Pair it with the Psychosocial assessment form to map supports and stressors, and add the Hamilton depression rating scale form to quantify depressive severity. For ongoing follow-up, invite patients to log daily mood and triggers with the Mental health journal form so you can spot trends and adjust treatment earlier.

Must Ask Psychiatrist Interview Questions

  1. What brought you in today, and when did these problems start?

    This quickly surfaces the main concern and timeline, which guides your differential and next steps. It keeps the session focused and aligns expectations for the visit.

  2. How have these symptoms affected your sleep, appetite, energy, and concentration?

    Functional impact reveals severity and helps distinguish mood, anxiety, and attention issues. A brief screen like the Saringan minda sihat (dass-21) form can help quantify depression, anxiety, and stress.

  3. Have you had thoughts of harming yourself or others, or felt unsafe?

    Direct risk questions support timely safety planning and appropriate level of care. Clear documentation also improves handoffs and legal defensibility.

  4. What is your past mental health and medical history, including diagnoses, medications, therapy, and hospitalizations?

    History prevents contraindications and alerts you to prior treatment response. Use the Psychological assessment form if you need a fuller cognitive or personality workup.

  5. What supports and stressors are in your life right now, including relationships, work or school, housing, and substance use?

    Context clarifies triggers and protective factors that shape your care plan. It also identifies practical barriers you can address early.

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