Psychogenic Non-Epileptic Seizures (PNES) Therapy Intake Form

Professional PNES Therapy Intake Form for Mental Health Practitioners

Psychogenic non-epileptic seizures (PNES) represent a complex intersection of neurology and mental health, requiring specialized therapeutic approaches. This comprehensive intake form is designed specifically for therapists, psychologists, and counselors working with clients experiencing PNES, helping you gather critical information to inform evidence-based treatment planning.

Understanding the Unique Needs of PNES Treatment

PNES, also known as dissociative seizures or functional seizures, can be challenging to diagnose and treat. Unlike epileptic seizures caused by abnormal electrical activity in the brain, PNES episodes are manifestations of psychological distress—often linked to trauma, anxiety, depression, or other mental health conditions. Effective treatment requires a thorough understanding of the client's seizure patterns, medical history, psychological background, and previous interventions.

This intake form streamlines the initial consultation process by collecting essential information before the first session, allowing you to focus on building therapeutic rapport rather than administrative details. The form covers seizure characteristics and triggers, medical testing history including EEG and video-EEG monitoring results, neurological consultations, trauma history, current mental health status, and treatment goals.

Designed for Mental Health Professionals and Counseling Practices

Whether you're a licensed psychologist specializing in neuropsychology, a therapist with experience in trauma-informed care, or a counselor building expertise in functional neurological disorders, this intake form helps you establish a strong foundation for PNES treatment. The structured format ensures you capture the nuanced information needed to differentiate PNES presentations, identify co-occurring conditions, and develop individualized treatment plans incorporating cognitive behavioral therapy (CBT), trauma processing, or other evidence-based modalities.

For practices serving diverse client populations, the form's conditional logic adapts to each client's unique experience—asking relevant follow-up questions about specific triggers, medical procedures, or traumatic experiences only when appropriate. This sensitive approach respects client privacy while gathering the comprehensive information needed for effective case conceptualization.

Streamlined Workflow with Paperform and Integrated Tools

Built on Paperform's flexible platform, this intake form offers more than just data collection. The professional design creates a reassuring first impression for clients who may feel anxious about starting therapy. The multi-page layout breaks down potentially overwhelming questions into manageable sections, reducing form abandonment and improving completion rates.

Once submitted, client information flows seamlessly into your practice management system. Use Paperform's native integrations to automatically create client records in your EHR, schedule initial appointments, send personalized welcome emails, and trigger intake processing workflows. For practices requiring advanced automation, connect this form to Stepper (stepper.io) to build custom workflows that route high-risk cases for immediate review, assign new clients to appropriate clinicians based on specialization, or generate preliminary treatment plans based on presenting concerns.

Mental health professionals handling sensitive client data will appreciate Paperform's SOC 2 Type II compliance and robust security features, ensuring HIPAA-aligned data handling practices when combined with appropriate Business Associate Agreements. The platform's data residency controls and encryption standards meet the stringent requirements of healthcare providers while maintaining the user-friendly experience clients expect.

Supporting Evidence-Based PNES Treatment

Research consistently demonstrates that psychological interventions—particularly CBT adapted for PNES—lead to significant reductions in seizure frequency and improved quality of life. However, treatment success depends on accurate initial assessment and clear understanding of the complex factors contributing to each client's PNES presentation.

This intake form aligns with best practices in PNES assessment by systematically gathering information about seizure semiology, diagnostic journey, comorbid conditions, and psychosocial factors. The structured format helps you identify patterns that may not emerge in unstructured clinical interviews while ensuring no critical information is overlooked.

Customizable for Your Practice's Unique Approach

Every mental health practice has its own therapeutic orientation and assessment preferences. Paperform's intuitive editor makes it simple to customize this template to match your specific needs. Add questions about specific assessment measures you use, modify language to reflect your practice's voice, incorporate your branding for a cohesive client experience, or adjust conditional logic to align with your clinical decision-making process.

The form's calculation features can automatically score screening measures or risk assessments you incorporate, while the appointment booking functionality lets clients schedule their initial session immediately after completing intake—reducing no-shows and accelerating time to treatment.

Trusted by Mental Health Professionals Worldwide

Over 500,000 teams worldwide trust Paperform for their essential workflows, including therapists, counseling centers, and mental health clinics. The platform's reliability ensures your intake process never becomes a barrier to care, while the thoughtful design demonstrates your practice's commitment to professional, client-centered service.

For therapists and counselors specializing in PNES, functional neurological disorders, or trauma-related conditions, this intake form template provides a ready-to-use foundation that can be deployed immediately or customized to perfectly match your assessment approach. Start gathering the information you need to provide effective, evidence-based care from day one.