Q01
메시지
모든 템플릿
Family Therapy Intake and Concerns Assessment
Gathers a new family therapy client's presenting concerns, family structure, history, and goals before the first session, with an AI follow-up that explores the core relational conflict in the client's own words. Built for family and marriage therapists to speed up intake and arrive at session one with real context.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
질문 15개 · 약 8분
Q02
단문형필수
Who is completing this intake form (your name and relationship to the family, e.g. 'parent', 'adult child')?
Q03
객관식필수
Who will be attending family therapy sessions?
- Both/all parents or guardians
- One parent or guardian
- Children or teens in the home
- Siblings
- Extended family (grandparents, etc.)
- Partner/spouse
Q04
장문형필수
In your own words, what is the main reason your family is seeking therapy right now?
Q05
객관식필수
Which areas is your family currently struggling with?
- Communication and conflict
- Parenting disagreements
- A recent major change (divorce, move, loss, illness)
- A child or teen's behavior or mental health
- Substance use in the family
- Financial stress
- Blended family or step-family adjustment
- Trust or infidelity
Q06
의견 척도필수
In the last 30 days, how often has conflict in your family disrupted daily life (meals, sleep, work, or school)?
척도: 0 – 10
최소:Never disrupted최대:Disrupted constantly
Q07
매트릭스필수
How would you rate the current state of these areas in your family?
5개 행 × 5개 열
- Communication between family members
- Trust and honesty
- Ability to resolve disagreements
- Emotional closeness
- Consistency in parenting or household rules
열: Very poor · Poor · Fair · Good · Very good
Q08
객관식필수
Has your family received counseling or therapy together before?
- Yes, and it helped
- Yes, but it didn't help much
- No, this is our first time
Q09
객관식필수
Are there any safety concerns we should know about before your first session (e.g. domestic violence, self-harm risk, active substance abuse)?
- Physical violence or fear of harm
- Thoughts of self-harm or suicide by a family member
- Active substance abuse affecting safety
- Child safety concern
Q10
AI 인터뷰
Gently explore the core relational conflict the respondent named as the main reason for seeking therapy: ask for a recent specific example of when it happened, who was involved, what each person did or said, and how it typically ends. If they flagged any safety concern, prioritize understanding current safety and whether they need immediate support rather than probing the conflict further, and note this clearly for the therapist. If their answer is vague or minimizing, ask what a hard week for this family actually looks like.
Q11
장문형
What would you consider a meaningful sign of progress after a few months of family therapy?
Q12
단문형
Is there anything about your family's culture, faith, or background you'd like your therapist to understand from the start?
Q13
드롭다운
What is the approximate age range of the youngest child involved in therapy, if any?
- No children involved
- Under 5
- 5-9
- 10-13
- 14-17
- 18 or older
Q14
객관식
Household income range (optional, helps us discuss fee options if relevant)
- Under $30,000
- $30,000-$59,999
- $60,000-$99,999
- $100,000 or more
- Prefer not to say
Q15
메시지
Thank you for sharing this with us — it takes courage to reach out. Your therapist will review these answers before your first session so you can spend that time talking about what matters most, not filling out forms.
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
- Captures presenting concerns, family structure, history, and goals in the client's own words before session one, so therapists arrive with real context
- Includes an AI follow-up interview that gently explores the core relational conflict the client named as their main reason for seeking therapy, going beyond a static field
- Covers practical intake needs therapists need before a first session — who's attending, prior counseling history, safety concerns, and a matrix rating current family functioning across key areas
- Closes with a warm, transparent chat message setting expectations for how the shared information will be used in the first session
Jotform
Family Therapy Intake Form TemplateA ready-to-field static intake form builder template covering standard family therapy intake fields like contact info and presenting concerns. It's a form-builder product, so customization is flexible, but every respondent sees the same fixed question set. No mechanism exists to probe deeper into a stated concern.
잘하는 점
- Fielding-ready template usable immediately
- Familiar drag-and-drop form builder for easy customization
- Likely supports file uploads and e-signature for intake paperwork
아쉬운 점
- Static form with no adaptive follow-up to explore the client's stated concerns further
- No AI-driven quality scoring of responses
- No voice interview option for clients who prefer speaking over typing
Typeform
Family Therapy Intake Form TemplateA polished, conversational one-question-at-a-time intake template well-suited to therapy's sensitive tone. It relies on branching logic rather than genuine AI-driven follow-up, so it can route respondents down predefined paths but cannot dynamically generate a new question based on what a client actually writes.
잘하는 점
- Clean, conversational UI that suits a sensitive intake context
- Logic-based branching to skip/show questions based on prior answers
- Strong mobile-friendly design and completion experience
아쉬운 점
- No adaptive AI follow-up that responds to the client's own words about their core conflict
- No automated per-response quality scoring or auto-generated clinical-context reports
- No optional voice AI interview mode for clients who prefer talking
설문을 공개할 준비가 되셨나요?
이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.