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Healthcare · Automation Kit

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

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
  • 4 Extras

Plus: Bilingual intake (English + Spanish) with mirrored branching, Mobile-first design tested on phones and tablets, Printable patient-facing summary for personal records …and more

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

Kit contents

HIPAA Therapy Intake Kit

  1. 01Branching intake by therapist, visit type (in-person vs telehealth), and presenting concernform
  2. 02Sliding-scale fee disclosure block (cash-pay) with insurance card upload (insurance)form
  3. 03Mental-health history with current medications, prior providers, and first-time vs returning logicform
  4. 04PHQ-9 and GAD-7 baseline screening with auto-scoringform
  5. 05Telehealth-only block: tech check, video consent, platform preferenceform
  6. 06Separate dated consent form (telehealth risks, no-show, ROI, privacy notice) with e-signatureform
  7. 07Patient confirmation with first-session expectations - zero PHI in bodyemail
  8. 08Front-desk notification - 'new submission, click to view' with no clinical content in emailemail
  9. 09Therapist notification - PHI-stripped, links to authenticated Jotform viewemail
  10. 10Resume-link email if the patient abandons mid-formemail
  11. 1124-hour pre-visit reminder (telehealth pre-visit kit handoff for video sessions)email
  12. 12Conditional branching invisible to the patient - one continuous form that adaptsworkflow
  13. 13Auto-routing of submission to the named therapist + office manager onlyworkflow
  14. 14PHQ-9/GAD-7 high-score flagging for clinical review before first sessionworkflow
  15. 15Consent expiry tracking with annual re-consent promptworkflow
  16. 16Audit-trail notes on every submission for licensing-board readinessworkflow
  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 intakeintegration
  20. 20PHI-safe storage (encrypted Drive folder under BAA, or Jotform-only retention)integration
  21. 21Calendar handoff to Google Calendar, Calendly, or SimplePractice schedulingintegration
  22. 22Bilingual intake (English + Spanish) with mirrored branchingextra
  23. 23Mobile-first design tested on phones and tabletsextra
  24. 24Printable patient-facing summary for personal recordsextra
  25. 25Decision-log template documenting every BAA in the data pathextra
Installs in: JotformTested with: Gold or Enterprise, SimplePractice and, DrChrono andKit v1.0 · Updated Apr 2026

System diagram

01FORM02LOGIC03OUTPUT
The solution

How this kit actually works.

A Jotform-built therapy intake configured by a Jotform HIPAA expert who has shipped this exact pattern for 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, ready the day you buy it.

Forms

  • Branching intake by therapist, visit type (in-person vs telehealth), and presenting concern
  • Sliding-scale fee disclosure block (cash-pay) with insurance card upload (insurance)
  • Mental-health history with current medications, prior providers, and first-time vs returning logic
  • PHQ-9 and GAD-7 baseline screening with auto-scoring
  • Telehealth-only block: tech check, video consent, platform preference
  • Separate dated consent form (telehealth risks, no-show, ROI, privacy notice) with e-signature

Emails

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

Workflows

  • Conditional branching invisible to the patient - one continuous form that adapts
  • Auto-routing of submission to the named therapist + office manager only
  • PHQ-9/GAD-7 high-score flagging for clinical review before first session
  • Consent expiry tracking with annual re-consent prompt
  • Audit-trail notes on every submission for licensing-board readiness

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
  • PHI-safe storage (encrypted Drive folder under BAA, or Jotform-only retention)
  • Calendar handoff to Google Calendar, Calendly, or SimplePractice scheduling

Extras

  • Bilingual intake (English + Spanish) with mirrored branching
  • Mobile-first design tested on phones and tablets
  • Printable patient-facing summary for personal records
  • Decision-log template documenting every BAA in the data path
Pricing

Pick the fit. Upgrade later if you need to.

Base Kit

Ready to run, self-setup

$199

  • All forms, emails, and workflow configs (intake + consent + telehealth pre-visit)
  • HIPAA setup documentation specific to therapy practices
  • 45-minute video walkthrough of the configuration
  • PHQ-9 and GAD-7 scoring logic preconfigured
  • 14-day email support
Book a call
Most popular

Pro Setup

Kit + setup call + customization

$399

  • Everything in Base
  • 60-minute setup call with a Jotform HIPAA expert
  • BAA chain audit (Jotform + EHR + storage + scheduling)
  • EHR export configured for SimplePractice or TherapyNotes
  • Sliding-scale + insurance branching tuned to your fee schedule
  • 30-day email support
Book a call

Done-For-You

Full implementation by me

$799

  • Everything in Pro
  • Full implementation in your HIPAA Jotform account
  • Therapist + front-desk training session
  • Real-time API integration for DrChrono, Athena, or comparable EHR (where supported)
  • Bilingual intake variant (English + Spanish) configured
  • 90-day priority support and one post-launch tuning round
Book a call
Frequently asked

The questions I get before someone buys.

  • 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?

    The kit is designed for HIPAA compliance when deployed 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). Sliding-scale fees can be disclosed dynamically 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?

    Pick the Done-For-You tier or book a 20-minute scoping call from the contact page. 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.