Intake Assessment / First Interview Template
Opening rapport notes:
Marisol presented as guarded and visibly restless in the first few minutes. Thanked the clinic for a short waitlist while describing hesitation about starting therapy at all.
Presenting concerns (in client's own words):
Describes being "wound up from the moment I wake" for most of the past year, with three episodes of acute panic since October. Reports that evenings have become the hardest part of the day and that she has stopped answering calls after 8pm. States "I feel like I am running a meeting that never ends" and "my body forgot how to stop."
Emotional & physical symptom check:
Persistent worry across 11 months, with anticipatory dread most days. Sleep onset delayed by 90–120 minutes; wakes at 4:15AM on roughly 5 nights per week and is unable to return to sleep. Panic episodes lasting 8–12 minutes with chest tightness, shallow breathing and tingling in the hands, typically followed by two to three hours of fatigue. Appetite reduced — often one substantial meal per day, with snacks skipped due to nausea rather than lack of interest. Reports jaw tension and tension headaches averaging 4 days per week. No current suicidal ideation reported; denies self-harm history.
Brief life context:
Works as a logistics coordinator on rotating shifts and reports falling behind on scheduling accuracy since spring. Lives with a housemate but describes the flat as "somewhere I sleep." Ended a four-year relationship in August. Two close friends check in weekly, though she often replies days later. Family is