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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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질문 13개 · 약 7분
Q01
메시지

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
객관식필수

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
의견 척도필수

How clear was the explanation of confidentiality and its limits?

척도: 1 – 7
최소:Not clear at all최대:Extremely clear
Q04
매트릭스필수

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

5개 행 × 4개 열
  • 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
열: Not explained · Briefly mentioned · Clearly explained · Don't remember
Q05
객관식필수

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
평점 척도필수

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

범위: 1 – 5
최소:Very uncomfortable최대:Very comfortable
Q07
객관식

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
의견 척도필수

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

척도: 0 – 10
최소:Not at all likely최대:Extremely likely
Q09
AI 인터뷰

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
객관식

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
객관식

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
객관식

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q13
메시지

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.

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

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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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