Ketamine-Assisted Psychotherapy Screening Form

Streamline Your Ketamine-Assisted Psychotherapy Screening with Paperform

Ketamine-assisted psychotherapy (KAP) is emerging as a powerful treatment option for individuals with treatment-resistant depression, PTSD, and other complex mental health conditions. However, proper patient screening is critical to ensure safety, appropriateness, and therapeutic success. This Ketamine-Assisted Psychotherapy Screening Form helps mental health clinics, psychiatrists, and specialized treatment centers collect comprehensive patient information efficiently and securely.

Why This Template Works for Mental Health Professionals

This form template is specifically designed for mental health clinicians offering ketamine-assisted psychotherapy. It systematically captures psychiatric history, previous treatment attempts, medical contraindications, and readiness for integration work—all essential components of responsible KAP screening.

With Paperform's intuitive interface, you can collect sensitive mental health information in a HIPAA-aware workflow (when configured properly with your compliance requirements), present conditional questions based on patient responses, and create a professional, calming experience that reflects your practice's values.

Comprehensive Screening in One Streamlined Form

The template includes sections for:

• Psychiatric history and current symptoms to establish baseline mental health status
• Treatment-resistant depression documentation including previous medications, therapies, and outcomes
• Medical history and contraindications to identify any safety concerns
• Current medications and supplements that might interact with ketamine
• Substance use screening to ensure appropriate candidacy
• Integration session planning to prepare for post-treatment processing
• Informed consent acknowledgment to ensure patients understand the treatment approach

Automate Your Intake Workflow with Stepper

Once a patient submits their screening form, you can use Stepper to automatically trigger your clinical workflow. Route completed screenings to your medical team for review, send follow-up emails with pre-treatment instructions, schedule initial consultations, and update your patient management system—all without manual data entry.

For practices requiring formal treatment agreements, you can seamlessly connect submissions to Papersign to send consent forms, financial agreements, and treatment contracts for secure eSignature, creating a complete digital trail from screening through treatment authorization.

Built for Mental Health and Specialty Care Providers

Whether you're a psychiatrist adding KAP to your treatment options, a licensed therapist partnering with a medical provider, or a specialized ketamine clinic, this template adapts to your screening protocols. Paperform's conditional logic ensures patients only see relevant questions based on their responses, creating a more thoughtful and efficient screening experience.

Mental health professionals, psychiatric clinics, and integrative medicine practices trust Paperform to handle sensitive patient information with the security and professionalism their practice demands. With SOC 2 Type II compliance and robust data protection, you can focus on clinical decision-making while Paperform handles the intake workflow.

Start with this template and customize it to match your specific screening criteria, clinical protocols, and practice branding—all without needing any technical skills.