Healthcare & Clinical

Therapy Informed Consent Understanding Survey

Measures whether clients actually understood the informed consent process before starting therapy — confidentiality limits, fees, and their right to ask questions — rather than just whether they signed a form. Built for clinics and individual practitioners auditing their intake process, with an AI follow-up that digs into exactly what was unclear and what would have made it clearer.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分

Q01

メッセージ

Thanks for taking a few minutes to share your experience with the consent process when you started therapy here. Your honest feedback helps us make sure future clients fully understand what they're agreeing to. Your responses are completely confidential and anonymized. This should take about 4-5 minutes.

Q02

選択式必須

Before your first session, did you receive written or verbal information explaining confidentiality and its limits (e.g., situations where your therapist must break confidentiality)?

Yes, clearly explained
Yes, but briefly mentioned
No, not that I recall
Not sure

Q03

オピニオンスケール必須

How clear was the explanation of confidentiality and its limits?

スケール: 1 – 7

最小:Not clear at all最大:Extremely clear

Q04

マトリクス必須

How clearly do you feel each of the following was explained to you before you agreed to start therapy?

5行 × 4列

Confidentiality and its limits
Fees and cancellation/no-show policy
Therapist's approach, credentials, or licensure
What to do in a crisis or emergency
Your right to end treatment or change providers

列: Not explained · Briefly mentioned · Clearly explained · Don't remember

Q05

選択式必須

Did you feel you had enough opportunity to ask questions before agreeing to start therapy?

Yes, fully
Somewhat
No, not really
I didn't feel comfortable asking

Q06

評価スケール必須

Overall, how comfortable did you feel when signing or verbally agreeing to the consent terms?

範囲: 1 – 5

最小:Very uncomfortable最大:Very comfortable

Q07

選択式

Which parts of the consent process, if any, felt unclear or confusing to you? Select all that apply.

Confidentiality and its limits
Fees or cancellation policy
Emergency procedures
Therapist's qualifications or approach
How my information might be used or shared

Q08

オピニオンスケール必須

How likely would you be to tell a friend that this practice explains its consent process clearly?

スケール: 0 – 10

最小:Not at all likely最大:Extremely likely

Q09

AIインタビュー

Focus on whatever the respondent flagged as unclear or rated lowest, especially confidentiality limits since that's the most legally and ethically significant part of consent. Reconstruct specifically what was said or missing, what they assumed instead, and what language or format (verbal walkthrough, printed summary, examples) would have made it click. If they say everything was clear, ask them to explain confidentiality limits back in their own words to check real understanding, and gently probe any gaps.

Q10

選択式

About how long ago did you begin therapy at this practice?

Less than 1 month ago
1-6 months ago
6-12 months ago
More than a year ago
Prefer not to say

Q11

選択式

Which age range do you fall into?

Under 18
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to say

Q12

選択式

How do you describe your gender?

Woman
Man
Non-binary
Prefer not to say

Q13

メッセージ

Thank you for your candid feedback! Your responses will be reviewed by our clinical team (with identifying details removed where possible) to improve how we walk new clients through consent.

含まれる機能

AIによる深掘り
自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。
注意確認設問
急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。
AIが作成する設問文
文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。
自動レポート
回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

Goes beyond signature capture to test whether clients actually understood confidentiality limits, fees, and their right to ask questions
Uses a matrix question to score clarity across each individual consent topic, not just a single yes/no checkbox
Includes an AI follow-up interview that automatically digs into whatever the respondent flagged as unclear or rated lowest, capturing specifics a static form would miss
Adds a likelihood-to-recommend style question and demographic/timing context, letting clinics segment understanding gaps by how recently intake happened

Jotform

Teletherapy Informed Consent Form Template

This is a fillable consent form for teletherapy, designed to collect a client's agreement and signature before sessions begin, not to audit whether the client understood what they signed. It's built for the intake moment itself rather than a post-intake understanding check. Good as a drag-and-drop form builder but not structured as a research survey.

優れている点

Purpose-built for the teletherapy consent moment with e-signature capture
Easy to customize fields via Jotform's drag-and-drop builder
Likely integrates with Jotform's broader form and payment ecosystem

物足りない点

Collects a signature/agreement but has no mechanism to measure comprehension after the fact
No adaptive follow-up probing into what was unclear or confusing
No automated per-response quality scoring or reporting on understanding gaps

Typeform

Psychotherapy Informed Consent Form Template

A conversational-style form for capturing psychotherapy informed consent, likely used at intake to record agreement rather than to later evaluate whether the client understood the terms. Typeform's format is pleasant to fill out but is fundamentally a static consent-capture form. No indication it includes any post-intake auditing component.

優れている点

Conversational one-question-at-a-time UI that may feel less intimidating at intake
Clean, mobile-friendly design typical of Typeform templates
Simple to deploy as a standalone consent form

物足りない点

Fixed question flow with no adaptive AI follow-up to explore unclear areas
No built-in scoring of response quality or clarity
Not designed to generate a comprehension audit report for clinics

SurveyMonkey

Therapy Consent Form Template

A standard consent form template for therapy practices, oriented toward collecting agreement to terms rather than assessing client understanding afterward. It's a static, fielding-ready form built on SurveyMonkey's general survey infrastructure. No evidence it targets the specific audit-of-intake use case QuestionPunk's template addresses.

優れている点

Straightforward, ready-to-use consent form template
Backed by SurveyMonkey's established survey distribution and analytics tools
Likely supports basic branching and reporting on aggregate responses

物足りない点

No adaptive AI interview to probe what specifically felt unclear
No mechanism to distinguish 'signed the form' from 'understood the content'
No transparent, auto-generated per-respondent quality or comprehension scoring

SurveySparrow

Group Therapy Consent Form

A consent form specifically for group therapy settings, focused on capturing agreement from multiple participants rather than auditing comprehension of the consent terms. It's a fielding-ready form, not a post-consent understanding survey, and is narrower in scope (group therapy only) than a general intake consent audit. Useful for practices running group sessions but not a substitute for a comprehension check.

優れている点

Tailored specifically to group therapy consent scenarios
Ready-to-field template requiring minimal setup
Part of SurveySparrow's conversational survey platform with basic logic support

物足りない点

Scoped narrowly to group therapy, not general intake consent auditing
No adaptive AI follow-up to explore what was confusing or unclear
No automated quality scoring or comprehension-focused reporting

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