Q01
Message
All templatesHealthcare & 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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
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
Opinion ScaleRequired
How clear was the explanation of confidentiality and its limits?
Scale: 1 – 7
Min:Not clear at allMax:Extremely clear
Q04
MatrixRequired
How clearly do you feel each of the following was explained to you before you agreed to start therapy?
5 rows × 4 columns
- 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
Columns: Not explained · Briefly mentioned · Clearly explained · Don't remember
Q05
Multiple ChoiceRequired
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
Rating ScaleRequired
Overall, how comfortable did you feel when signing or verbally agreeing to the consent terms?
Range: 1 – 5
Min:Very uncomfortableMax:Very comfortable
Q07
Multiple Choice
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
Opinion ScaleRequired
How likely would you be to tell a friend that this practice explains its consent process clearly?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q09
AI Interview
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
Multiple Choice
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
Multiple Choice
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
Multiple Choice
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer not to say
Q13
Message
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.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- 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 TemplateThis 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.
What it does well
- 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
Where it falls short
- 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 TemplateA 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.
What it does well
- 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
Where it falls short
- 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 TemplateA 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.
What it does well
- 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
Where it falls short
- 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 FormA 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.
What it does well
- 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
Where it falls short
- 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
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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