Mind Matters NE

Patient Questionnaire

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Patient Questionnaire

At Mind Matters NE, we understand that every individual’s journey to mental well-being is unique. That’s why we’ve developed a brief Patient Questionnaire designed to gather essential information about your current mental health status and treatment preferences. Completing this form provides valuable insights into your specific needs and challenges, allowing us to tailor our counselling and therapy services to suit you best.

Mental Health Counselor

Why Complete the Patient Questionnaire?

Please take a moment to fill out the questionnaire and submit it before your first appointment. Your therapist will review your responses and provide feedback during the initial session.

Rest assured, all information shared is strictly confidential and will be used solely to inform your personalised treatment plan. Your well-being is our priority; this questionnaire is the first step towards achieving the positive changes you seek.

Patient Questionnaire

All new patients are required to complete the Patient Questionnaire. The information submitted will be treated in the strictest of confidence and will be used to establish the most effective path of treatment for the patient.

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Name

First

Last

Your Email Address

Email

Confirm Email

Please enter a valid email address

Telephone Number

Emergency Telephone Number (if different)

Your Address

Postcode

Please give your reason for seeking help

Describe the symptoms or challenges you are experiencing

What has been the duration of any symptoms or challenges

All information that you provide will be treated in the strictest of confidence

Any Previous Mental Health Treatment or Therapy?

All information that you provide will be treated in the strictest of confidence

Any Current Medications (if applicable)

All information that you provide will be treated in the strictest of confidence

Any Allergies or Medical Conditions

All information that you provide will be treated in the strictest of confidence

Are there any additional comments or concerns we need to be aware of at this stage?

All information that you provide will be treated in the strictest of confidence

Please indicate what is your preferred session format (select one)

In-person (face-to-face)
Online (GoogleMeet or Teams)
Telephone Consultation

If you decide that your would like to change your session format at any stage just let the team know

Please indicate your availability for appointments

This can be morning, afternoon, early evenings, weekdays or weekends. We will try to accommodate as best as we can.

What Happens next?

After you complete the patient questionnaire, our team at Mind Matters NE will review your responses carefully to understand your unique needs. We’ll reach out to you within 48 hours to discuss your answers and suggest the best treatment options tailored specifically for you. Our goal is to ensure you receive the right support as quickly as possible, so you can start your journey towards better mental health without delay.

Ready to take the first step towards improved mental health? Complete our patient questionnaire now and empower your path to wellness today!

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Have more questions?

We hope this FAQ section provides you with the information you need to take the next steps towards improving your mental health and well-being.

If you have any questions or require further assistance, please don’t hesitate to reach out.

We’re here to support you on your journey to mental wellness. Mind Matters NE

Get In Touch

Contact Mind Matters NE for any inquiries or questions or to gather further details. Simply fill out the contact form, or feel free to reach us via phone or email.

Our primary goal is to support you on your journey towards wellness, ensuring that no question is too big or too small.

Count on Mind Matters NE for our dependable support and expert guidance to navigate you back to the right path.