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The form collects direct narrative input on what brings the veteran to the clinic and how staff can help. It also asks about frequency of depression, sleep problems, fatigue, appetite changes, self-worth, concentration, psychomotor changes, suicidal thoughts, functional difficulty, anxiety symptoms, and trauma-related experiences over the last month, plus prior diagnoses and psychiatric hospitalization history.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/va-medical-center-va-behavioral-health-outpatient-clinic-intake-questionnaire-mental-health-assessment/307663/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/va-medical-center-va-behavioral-health-outpatient-clinic-intake-questionnaire-mental-health-assessment/307663.png","ImageObject",442,249,{"name":88,"@type":89},"Violet","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of this questionnaire for the VA Behavioral Health Outpatient Clinic?","Question",{"text":109,"@type":110},"It helps the clinic assess current mental health needs, understand why you chose to seek care, and recommend treatment options to support recovery.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What symptom areas does the form ask about for the last month?",{"text":114,"@type":110},"It covers depressed mood, sleep problems, low energy, appetite changes, self-worth, concentration issues, psychomotor changes, suicidal-related thoughts, and anxiety symptoms.",{"name":116,"@type":107,"acceptedAnswer":117},"Does the questionnaire ask about trauma and prior mental health treatment?",{"text":118,"@type":110},"Yes. 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While you will be interviewed by a mental health specialist, answering these questions will help us to:  \n• Better assess your current needs.  \n• Understand the reasons you’ve chosen to seek mental health care.  \n• Recommend different types of treatments to assist in your recovery.  \nThe following pages include questions that help us assess your mental health needs, but also take abroader perspective that includes your social and cultural history that help us understand you as a whole person.  \nPlease answer to the best of your ability and knowledge. Please talk directly with your mental health specialist about any questions that you do not know or understand, if you are unable to recall, or if you choose to decline to answer.  \nPlease explain what brings you to our clinic. How can we help you?  \n______________________________________________________________ ______________________  \n____________________________________________________________________ ________________  \n__________________________________________________________________________ __________  \nOVER THE LAST MONTH, HOW OFTEN HAVE YOU BEEN BOTHERED BY THE FOLLOWING:  \n(Please check the appropriate box)  \nLittle interest or pleasure in doing things:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day Feeling down, depressed, or hopeless:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day Trouble falling asleep, staying asleep, or sleeping too much:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day Feeling tired or having little energy:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day Poor appetite or over eating:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day  \nFeeling bad about yourself; that you are a failure or that you have let yourself or your family down:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day  \nTrouble concentrating on things, such as reading the newspaper or watching television:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day  \nMoving or speaking so slowly that other people could notice   or being so fidgety and restless that you have been moving around a lot more than usual:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day Thoughts that you would be better off dead, or of hurting yourself:  \n□ Not at all □ Several days □ More than half the days □ Nearly every day  \nIf you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?  \n□ Not difficult at all □ Somewhat difficult □ Very difficult □ Extremely difficult  \n(Please check the appropriate box)  \nFeeling nervous, anxious, or on edge:  \n□ Not at all □ Several days □ More than ha","cbCaimMLwz1xLNNl","https://ap.wps.com/l/cbCaimMLwz1xLNNl","pdf",502751,"English","# General Mental Health Services\n## Behavioral Health Outpatient Clinic Introduction\n## Over the Last Month Symptom Frequency\n## Functional Difficulty From Symptoms\n## Trauma and Mental Health History","[{\"question\":\"What is the purpose of this questionnaire for the VA Behavioral Health Outpatient Clinic?\",\"answer\":\"It helps the clinic assess current mental health needs, understand why you chose to seek care, and recommend treatment options to support recovery.\"},{\"question\":\"What symptom areas does the form ask about for the last month?\",\"answer\":\"It covers depressed mood, sleep problems, low energy, appetite changes, self-worth, concentration issues, psychomotor changes, suicidal-related thoughts, and anxiety symptoms.\"},{\"question\":\"Does the questionnaire ask about trauma and prior mental health treatment?\",\"answer\":\"Yes. It asks whether you experienced or witnessed life-threatening events and related past-month symptoms, and whether you have been diagnosed with a mental health condition or hospitalized for psychiatric reasons.\"}]","VA Medical Center - VA Behavioral Health Outpatient Clinic Intake Questionnaire - Mental Health Assessment | PDF",1789852816]