Maternal Depression Screening & Support Services Form

Supporting Maternal Mental Health Through Early Screening

Maternal depression affects up to 1 in 7 women during pregnancy and the postpartum period, yet many cases go undetected and untreated. This Maternal Depression Screening & Support Services Form provides a standardized, compassionate approach to identifying perinatal mental health concerns and connecting mothers with the support they need.

Built on the evidence-based Edinburgh Postnatal Depression Scale (EPDS), this template helps healthcare providers, social services agencies, public health departments, and community organizations conduct sensitive mental health assessments during the critical perinatal window. The form captures essential information about postpartum timeline, mood symptoms, infant bonding experiences, and available social support networks to create a complete picture of each mother's wellbeing.

Designed for Government & Social Service Providers

This template is ideal for public health departments, WIC programs, maternal health clinics, community mental health centers, family resource centers, and social services agencies that provide support to new and expecting mothers. The structured assessment helps identify mothers who may benefit from counseling, support groups, home visiting programs, or clinical mental health treatment.

By standardizing the screening process, you can ensure consistent care across your organization, track outcomes over time, and connect mothers with appropriate resources based on their specific needs and risk factors. The form includes conditional logic to gather additional details when concerning symptoms are identified, while maintaining a supportive and non-judgmental tone throughout.

Streamline Referrals and Follow-Up with Paperform

With Paperform's conditional logic, you can automatically route high-risk screenings to clinical staff, send personalized resource lists based on screening results, and trigger follow-up workflows through Stepper (stepper.io) to ensure no mother falls through the cracks. Integration with your case management systems, EMRs, or CRMs means seamless data flow and coordinated care across your team.

Whether you're implementing universal screening protocols, managing grant-funded maternal health programs, or expanding access to perinatal mental health services, this template provides a professional, HIPAA-aware foundation that respects the sensitivity of maternal mental health while gathering the clinical information needed to provide effective support.