Therapists often ask about what to include in an intake questionnaire. The answer to that varies and depends somewhat on your theoretical orientation. Still, there are questions that should be asked when considering therapy online. It is good to know what operating system and access to internet your potential client has. And you might want to know what experience your potential client has with cyber culture. Depending on your area of expertise, you might also ask questions related to your client’s use of the internet- how much time spent online, for what purpose, and other related questions.
An example of an intake questionnaire can be found here:
This questionnaire is designed as an initial inquiry:
https://OTI.medforward.com/FillOutForm.aspx?formname=Client_Services_Request
This questionnaire is a more thorough intake similar to a biopsychosocial:
https://oti.medforward.com/FillOutForm.aspx?formname=Client_Questionnaire
This questionnaire was designed MedForward. MedForward is Verified by Online Therapy Institute and offers HIPAA compliant, secure and encrypted forms like this one.
A completed questionnaire is offered for review. The contents of the questionnaire were excerpted from a fictional composite for illustration purposes only and first appeared in
Anthony, K. & Nagel, D.M. (2010). Online therapy: A practical guide. Sage Publishing: London, pp 87-91.
Download the completed Intake Questionnaire
Client Questionnaire by Online Therapy Institute, Inc. is licensed under a Creative Commons Attribution 3.0 Unported License.
If this Client Questionnaire is duplicated in it’s entirety, proper credit must be given to Online Therapy Institute.
