Psychiatric evaluation template
Sigmund | Published October 26, 2026

For qualified clinicians and supervised trainees. Blank educational scaffold; adapt to the actual encounter. No patient information or prefilled findings.

Encounter date, setting and participants:
Information sources, consent and limitations:
Presenting concern and patient priorities:
History of the current concern and functional impact:
Prior psychiatric care and treatment responses:
Current medicines, supplements, allergies and adverse effects:
Medical history and relevant available results:
Substance use history:
Family, developmental and social history:
Mental status examination: see prompts below
Safety assessment, supporting information and clinical reasoning:
Formulation and differential diagnosis:
Working diagnoses and remaining uncertainty:
Options discussed, preferences and agreed plan:
Follow-up, coordination and responsibilities:
Clinician review and signature:

Mental status examination prompts

Appearance, behavior and engagement:
Psychomotor activity:
Speech:
Mood reported by the patient:
Affect observed:
Thought process:
Thought content and safety-related findings:
Perceptual experiences:
Cognition and any assessment performed:
Insight and judgment:
Assessment limitations:

References and limitations: https://sigmunds.ai/resources/psychiatric-evaluation-template/