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Psychology Questionnaire Form Template

Assess Patient Insights Effectively with Our Psychology Questionnaire

Creating a clear understanding of your patients' mental health can be a challenge. This psychology questionnaire form template is designed for professionals like you who want to efficiently gather insightful data to support diagnosis and treatment decisions. With this template, you can streamline patient assessments, enhance data collection for psychological evaluations, and improve the overall patient experience with well-structured survey questions. Plus, it's fully customizable and WCAG-aligned to ensure accessibility for all users. Start utilizing this live template to elevate your practice.

Use this Template (FREE) Live Preview
I am 18 years or older and consent to take part in this questionnaire.
Yes
No
Type your full name to confirm your consent.
Date
I understand this questionnaire is for informational screening and is not a diagnosis.
Yes
No
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
What is your gender identity?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Little interest or pleasure in doing things.
Never
Rarely
Sometimes
Often
Always
Feeling down, depressed, or hopeless.
Never
Rarely
Sometimes
Often
Always
Feeling nervous, anxious, or on edge.
Never
Rarely
Sometimes
Often
Always
Trouble falling or staying asleep, or sleeping too much.
Never
Rarely
Sometimes
Often
Always
How easy or difficult has it been to carry out your usual daily responsibilities?
Very difficult
Difficult
Neutral
Easy
Very easy
On a typical night, how many hours of sleep do you get?
Less than 5 hours
5 to 6 hours
6 to 7 hours
7 to 8 hours
8 to 9 hours
More than 9 hours
Varies a lot
How often do you engage in physical activity that raises your heart rate (at least 30 minutes)?
Never
Rarely
Sometimes
Often
Always
In the past month, how often did you have a drink containing alcohol?
Never
Monthly or less
2-4 times a month
2-3 times a week
4 or more times a week
Prefer not to say
In the past 3 months, have you used recreational drugs?
Yes
No
Over the past two weeks, how often have you had thoughts of harming yourself or that you would be better off dead?
Never
Rarely
Sometimes
Often
Always
Prefer not to say
Do you currently feel safe?
Yes
No
What is your primary concern or goal for seeking help right now?
Have you ever received mental health treatment or counseling?
Yes
No
Email address (optional)
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Paper art illustration showcasing a psychology questionnaire form template for FormCreatorAI article

When to use this form

Use this template when you need a quick, structured check on mood, anxiety, stress, and daily functioning. It works for intake at clinics, student services, and telehealth, and for progress check-ins between sessions. If you want standardized scores for depression and anxiety, pair your form with the PHQ-9 & GAD-7 form. For broader stress and mood screening across settings, add the Saringan minda sihat (dass-21) form. When a client flags complex social or family factors, continue with the Psychosocial assessment form to capture context. If loss is a concern, route them to the Grief assessment form. The result: cleaner data, faster triage, and clearer next steps for care or referral.

Must Ask Psychology Questionnaire Questions

  1. What brings you to seek support today?

    This opening prompt surfaces the main concern in the client's own words. It guides your follow-up questions and helps you route the submission to the right service.

  2. Over the past two weeks, how often have you felt little interest or pleasure in doing things?

    This screens for anhedonia, a key marker of depression. Tracking frequency helps you gauge severity and monitor change over time.

  3. In the past two weeks, how often have you felt nervous, anxious, or on edge?

    This identifies anxiety patterns that may affect sleep, work, or school. Clear ratings inform whether self-help, brief support, or therapy is the best next step.

  4. Have you had any thoughts of harming yourself or others?

    A direct safety check is essential for risk assessment. Yes responses trigger your crisis protocol and urgent referral if needed.

  5. Have you had periods of unusually high energy, less need for sleep, or racing thoughts?

    These symptoms can signal mania or hypomania. If present, follow up with the Young mania rating scale (ymrs) form to support a timely referral or care plan.

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