Q01
메시지
모든 템플릿
New Client Counseling Intake Assessment
A pre-session intake for therapy and counseling practices that captures presenting concerns, symptom frequency, safety screening, and personal goals before the first appointment. An AI follow-up interview explores the client's own account of what's going on and what they hope will change, giving clinicians richer context than checkboxes alone before the first session.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
질문 15개 · 약 8분
Q02
동의필수
Before we begin, please review the following.
Q03
객관식필수
What's bringing you to counseling right now? Select all that apply.
- Anxiety or worry
- Low mood or depression
- Relationship or family conflict
- Grief or loss
- Work or academic stress
- A specific past experience or trauma
- Life transition (move, job, breakup, etc.)
- Self-esteem or identity
- Substance use
- Not sure yet
Q04
장문형
In your own words, what's been going on lately, and what made now the right time to reach out?
Q05
의견 척도필수
Overall, how would you rate your emotional well-being over the past two weeks?
척도: 1 – 10
최소:Struggling a great deal최대:Doing very well
Q06
매트릭스필수
Over the past two weeks, how often have you experienced each of the following?
8개 행 × 5개 열
- Trouble sleeping or sleeping too much
- Changes in appetite
- Low energy or fatigue
- Difficulty concentrating
- Feeling anxious or on edge
- 외 3개
열: Never · Rarely · Sometimes · Often · Nearly every day
Q07
객관식필수
In the past two weeks, have you had any thoughts of harming yourself or that life isn't worth living?
- No
- Yes
- Prefer not to answer
Q08
메시지
If you're in crisis or thinking about harming yourself right now, please contact 988 (Suicide & Crisis Lifeline) or your local emergency number immediately — you don't need to wait for your first session. (Template note: replace with the correct crisis line for your country/region before launching.)
Q09
객관식
Have you received counseling or therapy before?
- No, this is my first time
- Yes, in the past
- Yes, I'm currently also seeing another provider
- Prefer not to say
Q10
순위 매기기
Rank the following in order of what you most want to get out of counseling, starting with your top priority.
- Reduce anxiety or worry
- Improve a relationship or communication
- Process grief or loss
- Manage stress or burnout
- Work through a specific past experience
- Build self-esteem or confidence
드래그하여 순위 지정
Q11
AI 인터뷰
Explore the client's top-ranked goal and their earlier description of what's going on: ask when this started, what tends to trigger or worsen it, what they've already tried to cope with it, and what a realistic 'better' would look like to them in a few months. If they picked 'not sure yet' for their concerns or left the description blank, gently help them articulate what prompted them to reach out now rather than pressing for a diagnosis.
Q12
객관식
Which session format works best for you going forward?
- In-person
- Video call
- Phone call
- No preference
Q13
객관식
What is your age range?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q14
객관식
What is your gender identity?
- Woman
- Man
- Non-binary
- Prefer not to say
Q15
메시지
Thank you for sharing this with us. Your counselor will review these answers before your first session so you can spend more of that time on what matters most to you. If you selected that you're having thoughts of self-harm, someone from our team may reach out before your appointment to check in.
포함된 기능
AI 후속 질문
정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.
주의력 확인 장치
성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.
AI가 작성한 문안
문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.
자동 리포트
응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.
다른 서비스와 비교
다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.
이 템플릿을 선택하는 이유
- Includes a dedicated safety screening question on self-harm/suicidal ideation paired with an immediate crisis-resource message, not just a generic health disclaimer.
- Combines structured symptom-frequency tracking (matrix) and emotional well-being rating with an open-ended narrative question, then uses an AI follow-up interview to explore the client's top-ranked counseling goal and their own account of what's going on in more depth than checkboxes or a single text box could.
- Captures prior counseling history, preferred session format, and ranked goals so the intake informs both clinical context and logistics before the first appointment.
- Uses consent and closing chat messages to set expectations and reassure the client their counselor will review responses before the session, framing the intake as part of the therapeutic relationship rather than paperwork.
Jotform
Counseling Intake Form TemplateA ready-to-field static form covering standard counseling intake fields like contact info, presenting concerns, and history. It's a traditional form builder template, easily customizable with widgets and e-signature, but it doesn't adapt the questioning based on what a client actually writes.
잘하는 점
- Fielding-ready template with drag-and-drop customization
- Supports e-signature and file upload widgets common in intake paperwork
- Broad template library suggests easy integration with existing clinic workflows
아쉬운 점
- No adaptive AI follow-up to probe a client's presenting concerns or goals beyond fixed fields
- No automated per-response quality scoring or clinician-facing report generation
- No voice AI interview option for clients who prefer speaking over typing
Typeform
Counseling Intake Form TemplateA conversational, one-question-at-a-time intake template that likely feels warmer than a typical PDF-style form. It relies on static logic branching rather than true adaptive interviewing, and any deeper exploration of a client's narrative would need to be built manually with conditional logic.
잘하는 점
- Polished conversational UI that may reduce intake friction for clients
- Logic/branching capability for basic personalization
- Strong design and mobile-friendly presentation
아쉬운 점
- No AI-driven follow-up questions that adapt to a client's actual written answers
- No built-in safety-screening-to-crisis-resource flow described
- No transparent prompt methodology or automated clinical report generation
SurveyMonkey
Client Intake Form TemplateA generic client intake template aimed at businesses broadly rather than therapy/counseling practices specifically, so it would need significant customization for clinical use (symptom checklists, safety screening, etc.). It's a fielding-ready survey but static in structure.
잘하는 점
- Established survey platform with solid reporting/analytics dashboards
- Easy to customize question types for general intake needs
- Wide familiarity among respondents
아쉬운 점
- Not counseling-specific out of the box — lacks clinical elements like symptom frequency matrices or safety screening
- No adaptive AI interview to explore a client's own account of their concerns
- No voice AI interview or guided screen-share task options
SurveySparrow
Sample client intake form templateA general-purpose, printable-leaning client intake template for businesses rather than a counseling-specific tool; useful as a starting structure but would require substantial rework to cover clinical safety screening and presenting-concern nuance. It's a static template, not an adaptive interview.
잘하는 점
- Conversational survey format similar to chat-style intake
- Printable/exportable option convenient for offline paperwork workflows
- Simple setup for general business client intake
아쉬운 점
- Not tailored to therapy/counseling contexts (no safety screening or symptom tracking shown)
- No AI follow-up interview or adaptive probing of client responses
- No automated quality scoring or clinician-facing report generation
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이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.