The Therapy Intake Form is a critical document used at the commencement of therapeutic services in Malta, serving as both a clinical and legal instrument. It must comply with the Maltese Mental Health Act, Healthcare Professions Act, and EU GDPR requirements. This document is typically completed during or before the first therapy session, collecting essential information about the client's personal details, medical history, mental health concerns, and emergency contacts. The form includes necessary consent declarations and privacy notices, establishing the framework for the therapeutic relationship while protecting both the client's and practitioner's interests. It serves as a foundation for treatment planning and maintains compliance with regulatory requirements for mental health services in Malta.
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1. Personal Information: Basic client details including name, date of birth, contact information, and preferred contact method
2. Emergency Contact Information: Details of emergency contacts and their relationship to the client
3. Medical History: Current and past medical conditions, medications, and treating physicians
4. Mental Health History: Previous mental health treatment, hospitalizations, and current mental health concerns
5. Current Symptoms: Checklist and description of current symptoms and their severity
6. Risk Assessment: Questions regarding self-harm, suicide risk, and violence risk assessment
7. Privacy Notice: GDPR-compliant privacy notice explaining how personal data will be collected, used, and protected
8. Consent for Treatment: Informed consent section outlining therapy process, risks, benefits, and client rights
9. Financial Agreement: Session fees, payment policies, and cancellation procedures
10. Communication Policy: Guidelines for between-session communication and emergency procedures
1. Insurance Information: Details of health insurance coverage, if applicable for private practice
2. Medication List: Detailed current medication list, required if client is taking multiple medications
3. Family History: Family mental health history, included when relevant to treatment
4. Substance Use Assessment: Detailed substance use history, included when relevant to presenting problems
5. Cultural/Religious Considerations: Information about cultural or religious factors that may impact therapy
6. Recording Consent: Additional consent for session recording if used for training or supervision purposes
7. Telehealth Consent: Additional consent and protocols for online therapy services if offered
1. Symptom Checklist: Standardized checklist of mental health symptoms
2. Fee Schedule: Detailed breakdown of therapy fees and payment options
3. Privacy Policy: Detailed GDPR-compliant privacy policy and data protection procedures
4. Crisis Resources: List of emergency mental health resources and contact information
5. Client Rights Document: Detailed explanation of client rights under Maltese law
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