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Client History: Family

The Family section of the client history is comprised of current household, family members, and relationships.

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Current Household

List household members, relationship to client, age, and any remarks.

Indicate if, in your opinion, household conflicts may contribute to mental health issues.

Comments
 

Family Members

List family members, relationship to client, age, and remarks.

Indicate if there is a family history of mental illness.

Indicate your assessment of any family conflicts, including current household conflicts but not in any intimate relationships (spouse, etc.)

Indicate if, in your opinion, family conflicts may contribute to mental health issues.

Comments


Relationships
Describe the client’s relationship status, by selecting from the list or typing in another description.

Partner/Spouse Name, if applicable

Describe the client’s sexual orientation by selecting from the list or typing in another description.

List any past significant relationships.

Indicate your assessment of the severity of relationship conflicts.

Indicate if relationship conflicts may contribute to mental health issues

Comments
 

 

 

 

 

 

   

     
   

 

 

 

   

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