Biopsychosocial Assessment Template: 100+ Example Questions (PDF Download)

A biopsychosocial assessment is a holistic assessment used by health professionals to learn about their clients through the assessment of the biological, psychological, and social factors that are leading the client to treatment. Because of the breadth of this assessment, most therapists, clinicians, and other health professionals use a biopsychosocial assessment template. We will also go through biopsychosocial assessment example questions. Let’s get started.

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First proposed in 1977 by George Engel and since expanded, the biopsychosocial assessment template has become one of the most popular templates for clinical assessments for social workers, psychologists, psychotherapists, doctors, and more, and for good reason — it helps the clinician to gain a comprehensive understanding of the client’s mental health through the assessing of how various aspects of the client’s health interact with one another. A depiction of the interaction between biological, psychological, and social factors can be seen in the Venn diagram below.

What is a biopsychosocial assessment?

The holistic nature of the biopsychosocial assessment allows the clinician to answer the question of what is going on in the client’s life at the time of treatment, rather than simply asking what is wrong with the client.

The model contrasts the biomedical model which is based on the underlying assumption that good health is defined by the lack of illness. The biomedical model can be traced all the way back to the 400BC “father of medicine” Hippocrates, who advocated for a purely physical understanding of illness. The biomedical model became the predominant medical model in the Western World during the Scientific Revolution of the 1800s and remains as such to this day. However, a body of research suggests that the narrow scope of the biomedical model may hamper successful outcomes as it does not account for social or psychological health.

Meanwhile, the biopsychosocial model has been gaining increasing acceptance in medical communities for its ability to help providers understand the full scope of the client’s experience.

We’ll now take a look at the components which make up the biopsychosocial assessment and then we will go over biopsychosocial assessment example questions.

Biological factors

Biological factors that may influence mental health include:

• Physical health (including chronic or acute illness)
• Physical disabilities
• Genetic predispositions

Biological-psychological factors may include:

• Substance issues
• Cognitive disabilities
• Medications.

Biological-social factors may include present or past lifestyle including diet, exercise, and sleep habits, stability and quality of housing, and access to medical care and needed physical resources.

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Click here to download my biopsychosocial assessment template

Psychological factors

Any history of mental health issues

• Current symptomology including mood and affect
• Thoughts and beliefs which may benefit or detract from psychological well-being
• Self-esteem/body image
• Personality
• Stage of life

Psychological-social factors may include:

• Trauma
• Grief
• Finances
• Socio-economic issues including education, occupation, safety concerns

Social factors

Social factors that may influence mental health include:

• Family dynamics
• Family history
• Relationships
• Quality of current or past social support
• Degree of community engagement

Demographics

The client demographics section includes the following details.

• Client’s name
• Date of birth
• Age
• Gender
• Sexual orientation
• Race
• Ethnicity
• Religion or faith

Presenting Problem(s)

The presenting problem may include:

• The reason why the client is seeking therapy
• How long these problems have been affecting the client
• The intensity of the client’s distress
• How the client’s problem(s) are affecting his/her/their daily life

Treatment Goal(s)

The treatment goals section may include:

• What the client would like to accomplish in therapy
• How the client’s life would be different if treatment were successful

Symptoms

The symptoms section helps the therapist to determine which symptoms the client has been experiencing in the recent past. It may feature:

• A symptoms checklist
• A write-in box for any symptoms

Mental Health

The mental health section may include:

• Any mental health services that the client has received in the past
• Any past or current mental health diagnoses
• Risk assessments (suicide, homicide, and harm to self or others)
• Questions about abuse, trauma, and grief

Lifestyle

The lifestyle section may include:

• Exercise habits and routines
• Sleep habits
• Eating/dietary habits, issues, or restrictions
• Substance use and/or addictions

Medical

The medical section may include:

• Psychiatric history
• Mental health diagnosis
• Any mental health hospitalizations
• Current medications
• Pregnancy
• Any acute or chronic medical conditions

Personal

The personal section may include (if applicable):

• Education background
• Student status and performance
• Current employment
• Employment history
• Retirement
• Military status and experience
• Living arrangements
• Homelessness
• Legal issues
• Financial issues
• Strengths
• Limitations

Relationship, Family, and Friends

The relationship, family, and friends section may include:

• Current relationship status
• Family relationships
• Friend/peer relationships
• Community engagement

Biopsychosocial Assessment Example: 100+ Questions

Here are some example questions that should be included in a Biopsychosocial Assessment. If you would like all these questions in a handy PDF format, download my template.

1. Patient Name
2. Date of Birth
3. Nickname/Preferred Name
4. Pronouns
5. Age
6. Gender
7. Sexual Orientation
8. Race/Ethnicity
9. Religion/Faith
10. Why are you seeking therapy?
11. How long have these problems been affecting you?
12. What is the intensity of your distress on a scale from 1 (least) to 10 (most)?
13. How is this problem(s) currently affecting your daily life?
14. What would you like to accomplish in therapy? 
15. What are your goals for therapy? 
16. If treatment were successful, what in your life would be different?
17. In the last 30 days, what symptoms have you experienced?
18. Have you received mental health service(s) in the past?
19. If yes, please list the person you saw, the reason for treatment, approximate dates, and outcome.
20. Have you ever received a mental health diagnosis?
21. If yes, please list any mental health diagnoses and include the approximate date.
22. Are you currently having any thoughts of suicide?
23. Have you had any thoughts of suicide in the past?
24. Have you ever tried to kill yourself?
25. If yes, please describe the circumstances, method, and outcome.
26. Are you currently thinking of killing or hurting someone else?
27. If yes, please describe.
28. Have you ever been abused in any way? 
29. If yes, please describe the situation and your relationship with the abuser including the approximate dates and duration of the abuse.
30. Have you ever been the victim of a traumatic or near-death experience?
31. If yes, please describe your experience.
32. Have you been abusive in any way towards others?
33. If yes, please describe the situation and your relationship with the individual(s) involved including the approximate dates and duration of the abuse.
34. Have you experienced significant grief or loss such as the loss of a loved one, divorce, or job?
35. If yes, please describe your experience.
36. In the last 30 days, what are your exercise habits and routines?
37. What are your current sleep habits? 
38. How much sleep do you usually get per night? 
39. Describe any sleep issues that you may have.
40. What are your current eating habits? 
41. What do you usually eat and at what times? 
42. Describe any eating issues that you may have.
43. Do you consume caffeine?
44. If yes, please describe your caffeine use including, how much, and how often.
45. If you use caffeine, would you like to reduce usage or quit?
46. Do you use any tobacco products?
47. If yes, please describe your tobacco use including what type, how much, and how often.
48. If you use tobacco, would you like to reduce usage or quit?
49. Do you drink any alcohol?
50. If yes, please describe your alcohol use including what type, how much, and how often.
51. If you use alcohol, would you like to reduce usage or quit?
52. Do you use any marijuana products?
53. If yes, please describe your marijuana use including how much and how often.
54. If you use marijuana, would you like to reduce usage or quit?
55. Do you use any other non-prescribed substances?
56. If yes, please describe your substance use including how much and how often.
57. Have you struggled with addiction of any kind?
58. If yes, please describe including your age at onset of addiction, duration of the addiction, triggers for the addiction, and family history of addiction.
59. If you have struggled with addiction, have you sought treatment?
60. If yes, what are the approximate dates, facility/hospital, duration, and outcome?
61. Are you currently seeing a psychiatrist?
62. If you are diagnosed, what is your diagnosis?
63. If yes, who is your psychiatrist?
64. Have you ever been hospitalized for psychiatric or mental health treatments?
65. If yes, what are the approximate dates, facility/hospital, reason, duration, and outcome?
66. Are you currently taking any prescribed medications?
67. If yes, what are your medications and what are they used for?
68. Are you currently pregnant?
69. If yes, when is your due date?
70. If yes, are there any complications to your pregnancy that are impacting your mental well-being?
71. If yes, please describe.
72. Do you have any medical issues that impact your mental well-being?
73. If yes, please describe.
74. What is your highest level of education?
75. Did you graduate?
76. What was/is your field of study?
77. Are you currently a student?
78. Have there been any changes in your school performance?
79. If yes, please describe.
80. Are you currently employed?
81. If yes, please describe. 
82. What do you do for work? 
83. What does your day look like? 
84. Do you enjoy it?
85. What is your work history?
86. Are you retired?
87. If yes, please describe your situation. 
88. What does your day look like? 
89. Do you enjoy being retired?
90. Have you ever served in the military?
91. If yes, what is your current military service status?
92. If yes, which branch?
93. If discharged, what type of discharge did you receive?
94. If you served in the military, please describe your service experience.
95. Who do you live with?
96. What is the condition of your home?
97. Do you have any risk of homelessness?
98. Have you ever been or are currently on probation or parole?
99. If yes, please describe.
100. Have you had or currently have any legal issues, such as custody orders, protection orders, lawsuits, incarceration, etc.?
101. If yes, please describe.
102. Do you have any financial issues?
103. If yes, please describe.
104. Are you financially planning for your future?
105. Please describe how you feel about your current financial status and plans for the future.
106. What are your strengths?
107. What are your limitations?
108. What is your relationship status?
109. Please describe how you feel about your relationship/relationship status.
110. Do you have close family members?
111. If yes, please list your close family members including age and relation to you.
112. If yes, how would you describe your relationship with your family members?
113. If yes, are there any past or current issues in your family, such as abuse, loss, or conflict?
114. If yes, what are your family’s strengths and limitations?
115. Do you have any family history of mental health issues?
116. If yes, please list including the relation and the issue.
117. Do you have close friends?
118. If yes, how would you describe your relationships with your friends?
119. Is there any additional information that you would like to share?

If you would like all these questions in a handy PDF format, download my template.

How to conduct an assessment using a Biopsychosocial Assessment Template

The biopsychosocial model is designed to aid the therapist with clinical formulation by specifically addressing the major factors that contribute to the client’s overall mental health: biological, psychological, and social factors. The goal of clinical formulation is two-fold:

• Understand how the client got to be the way he or she is
• Identify the best way of helping the client

Using a Biopsychosocial Assessment Template can help

Because of the breadth of a biopsychosocial assessment, most therapists use a template to organize the assessment process. While the order of some of the assessment components may vary from one template to the next, there is a general consensus on the content that should be included in a biopsychosocial assessment. Let’s go through the sections of a sample assessment.

Download my Biopsychosocial Assessment Template with Biopsychosocial Assessment Example Questions

Click here to download my template

Using the Biopsychosocial Assessment Template for Documentation

Most therapists use a template to conduct and document the assessment. A well-formatted, comprehensive, and easy-to-use biopsychosocial assessment template can make the process smooth and professional.

Since most biopsychosocial assessments are conducted during the client’s intake or assessment appointment, some templates are integrated with an intake note. The intake note section of the template includes additional items such as session information, intake discussions, a mental status exam, diagnosis, treatment plan status, plan for next appointments, and the therapist’s signature.

Download my biopsychosocial assessment template