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Healthcare · Automation Kit

Therapy intake that respects the work: HIPAA-clean, sliding-scale-ready, telehealth-aware

Updated May 5, 2026

Generic intake forms break down for therapy. Mental-health history needs to branch by presenting concern. Insurance and sliding-scale fees need to be disclosed up front, not after the first session. Telehealth needs its own consent and a tech check. Built by a generalist, the intake feels clinical and patients drop off; built without HIPAA judgment, the form leaks PHI through notification emails and unsigned-BAA integrations.

What you'll receive
  • 6 Forms
  • 5 Emails
  • 5 Workflows
  • 5 Integrations
  • 3 Extras

Plus: Bilingual intake variant (English + Spanish) with mirrored branching, Mobile-first design tested on phones and tablets, Decision-log template documenting every BAA in the data path

Installed in your Jotform account.
You own everything. No monthly fees to me.

Kit contents

HIPAA Therapy Intake Kit

  1. 0101: Branching intake by therapist, visit type (in-person vs telehealth), and presenting concernform
  2. 0202: Sliding-scale fee disclosure block (cash-pay) with insurance card upload (insurance)form
  3. 0303: Mental-health history: current medications, prior providers, hospitalizations, and first-time vs returning logicform
  4. 0404: PHQ-9 and GAD-7 baseline screening with auto-scoring (calculation fields total the score, conditional logic flags severity)form
  5. 0505: Telehealth-only block: tech check (device, camera, internet), video consent, platform preferenceform
  6. 0606: Separate dated consent form (telehealth risks, no-show policy, ROI, privacy notice) with e-signatureform
  7. 0701: Patient confirmation with first-session expectations: zero PHI in bodyemail
  8. 0802: Front-desk notification: 'new submission, click to view' with no clinical content in emailemail
  9. 0903: Therapist notification: PHI-stripped, links to authenticated Jotform view onlyemail
  10. 1004: Resume-link email if the patient abandons mid-formemail
  11. 1105: 24-hour pre-visit reminder (telehealth pre-visit kit handoff for video sessions)email
  12. 1201: Conditional branching invisible to the patient: one continuous form that adapts based on visit type and presenting concernworkflow
  13. 1302: Auto-routing of submission to the named therapist + office manager only (no other staff see it)workflow
  14. 1403: PHQ-9/GAD-7 high-score flagging: score > 15 on PHQ-9 or > 12 on GAD-7 triggers clinical review alert before first sessionworkflow
  15. 1504: Consent expiry tracking: annual re-consent prompt sent to returning patients if consent > 12 months oldworkflow
  16. 1605: Audit-trail notes on every submission for licensing-board readiness (who viewed, when, from where)workflow
  17. 17Jotform HIPAA plan (Gold or Enterprise) with signed BAA: requiredintegration
  18. 18SimplePractice and TherapyNotes via structured CSV batch importintegration
  19. 19DrChrono and Athena via webhook + API for real-time intake (Done-For-You tier)integration
  20. 20PHI-safe storage: encrypted Drive folder under BAA, or Jotform-only retentionintegration
  21. 21Calendar handoff to Google Calendar, Calendly, or SimplePractice schedulingintegration
  22. 22Bilingual intake variant (English + Spanish) with mirrored branchingextra
  23. 23Mobile-first design tested on phones and tabletsextra
  24. 24Decision-log template documenting every BAA in the data pathextra
Installs in: JotformTested with: Gold or Enterprise, SimplePractice and, Done-For-You tierKit v1.0 · Updated May 2026

System diagram

01FORM02LOGIC03OUTPUT
The solution

How this kit actually works.

I built this therapy intake after shipping the same pattern for three group practices. One branching form covers in-person and telehealth, sliding-scale and insurance, first-time and returning. Consent is its own dated, e-signed record. PHQ-9 and GAD-7 baseline on intake. Notifications are PHI-stripped. Submissions export to SimplePractice, TherapyNotes, or any EHR via structured CSV or API where supported.

What's included

Every piece, set up in your own account.

Forms

  • 01: Branching intake by therapist, visit type (in-person vs telehealth), and presenting concern
  • 02: Sliding-scale fee disclosure block (cash-pay) with insurance card upload (insurance)
  • 03: Mental-health history: current medications, prior providers, hospitalizations, and first-time vs returning logic
  • 04: PHQ-9 and GAD-7 baseline screening with auto-scoring (calculation fields total the score, conditional logic flags severity)
  • 05: Telehealth-only block: tech check (device, camera, internet), video consent, platform preference
  • 06: Separate dated consent form (telehealth risks, no-show policy, ROI, privacy notice) with e-signature

Emails

  • 01: Patient confirmation with first-session expectations: zero PHI in body
  • 02: Front-desk notification: 'new submission, click to view' with no clinical content in email
  • 03: Therapist notification: PHI-stripped, links to authenticated Jotform view only
  • 04: Resume-link email if the patient abandons mid-form
  • 05: 24-hour pre-visit reminder (telehealth pre-visit kit handoff for video sessions)

Workflows

  • 01: Conditional branching invisible to the patient: one continuous form that adapts based on visit type and presenting concern
  • 02: Auto-routing of submission to the named therapist + office manager only (no other staff see it)
  • 03: PHQ-9/GAD-7 high-score flagging: score > 15 on PHQ-9 or > 12 on GAD-7 triggers clinical review alert before first session
  • 04: Consent expiry tracking: annual re-consent prompt sent to returning patients if consent > 12 months old
  • 05: Audit-trail notes on every submission for licensing-board readiness (who viewed, when, from where)

Integrations

  • Jotform HIPAA plan (Gold or Enterprise) with signed BAA: required
  • SimplePractice and TherapyNotes via structured CSV batch import
  • DrChrono and Athena via webhook + API for real-time intake (Done-For-You tier)
  • PHI-safe storage: encrypted Drive folder under BAA, or Jotform-only retention
  • Calendar handoff to Google Calendar, Calendly, or SimplePractice scheduling

Extras

  • Bilingual intake variant (English + Spanish) with mirrored branching
  • Mobile-first design tested on phones and tablets
  • Decision-log template documenting every BAA in the data path
Get it running

I set this up in your own Jotform account.

Shaped to how your team actually works, on the tools you already pay for. A 20-minute call is enough to tell whether this fits or what needs to change.

Book a free 20-min call
Frequently asked

The questions I get before we talk.

  • Why do I need a therapy-specific kit instead of the general patient intake?

    Therapy intake branches differently. You need sliding-scale fee disclosure for cash-pay clients, insurance verification for billed sessions, presenting-concern branching that determines what history to collect, and PHQ-9/GAD-7 baseline screening that the general patient-intake kit does not include. The therapy kit also pairs intake with a separate dated consent form, which is what licensing boards expect to see for mental-health records.

  • Does this work with SimplePractice, TherapyNotes, or my EHR?

    Yes. SimplePractice and TherapyNotes do not have deep inbound APIs for intake, so the kit exports a structured CSV that imports cleanly into either, typically run as a weekly batch. For DrChrono, Athena, or other EHRs with proper APIs, the Done-For-You tier wires a real-time webhook + API call. Most 5-10 therapist practices find weekly CSV import is enough; high-volume practices step up to API.

  • Is this HIPAA-compliant for mental-health records?

    This kit meets HIPAA requirements when you deploy it on a Jotform HIPAA plan with a signed BAA. It also addresses the extra retention rules most states apply to mental-health records (typically 7 years for adults, often longer for minors). The kit includes the configuration to set retention at the account level. The Pro tier includes a BAA chain audit so every downstream tool (your EHR, scheduling, storage) is also under a signed BAA.

  • How do you handle PHI in notification emails?

    PHI never appears in email bodies. Both the front-desk and therapist notifications say only 'new submission for [therapist name]: click to view'. The recipient authenticates into Jotform to see the actual content. This is what auditors expect and is one of the most common gaps in setups built without HIPAA judgment. Someone sends the patient name in a Slack channel or in an email subject line and the practice has just breached.

  • Can solo therapists use this, or is it only for group practices?

    Solo therapists use it with the therapist-routing branch removed: just one variant. Setup time drops to about 5-7 days for a solo practice. The BAA, consent, telehealth pre-visit, and notification patterns transfer directly. Most solo therapists pick the Pro tier so the EHR export is configured for them.

  • What if I do not bill insurance?

    The form skips the insurance verification block entirely. Cash-pay-only practices get a slightly faster setup because there is one fewer integration to audit (no clearinghouse or insurance verification tool). The form discloses sliding-scale fees based on the patient's selection.

  • How is this different from hiring a generic Jotform freelancer?

    A generic freelancer will build the form. A Jotform HIPAA expert who has shipped therapy intake before knows that PHI cannot live in notification email bodies, that consent should be its own dated form, that PHQ-9/GAD-7 belongs at intake, that SimplePractice's inbound API is shallow, and that mental-health retention is governed by state law beyond the federal 6-year minimum. The judgment calls are where the time and risk live.

  • How do I hire you for a therapy practice setup?

    Want help with this? . Email me. We confirm number of therapists, EHR, telehealth needs, insurance billing, and jurisdictional retention rules, then send a fixed-price proposal within 48 hours. Most small and mid-sized therapy practices ship in about two weeks.

Not sure if this is the right kit?

Free 20-minute call. Tell me what you're trying to do. I'll tell you if a kit fits, or if you need something custom, or if you shouldn't pay me at all.