Physician Burnout Counseling Intake Form

Physician burnout is a critical issue affecting healthcare professionals across all specialties. This Physician Burnout Counseling Intake Form helps mental health counselors, therapists, and employee assistance programs gather essential information from physician clients experiencing burnout, compassion fatigue, or career dissatisfaction.

The form captures specialty-specific challenges, work environment factors, moral distress indicators, malpractice concerns, and overall career satisfaction—all critical data points for understanding the unique pressures facing today's physicians. By collecting this information upfront, counselors can tailor their approach to address the systemic and personal factors contributing to physician burnout.

Paperform makes it easy to create confidential, HIPAA-aware intake processes that respect the sensitive nature of mental health support for healthcare providers. With conditional logic, you can customize follow-up questions based on specialty or severity of symptoms, while encrypted submissions protect client privacy. The professional, on-brand design helps build trust from the first interaction.

For practices managing ongoing client relationships, connect this form with Stepper to automate appointment scheduling, send reminder emails, or route urgent cases to the appropriate provider. You can also integrate with practice management software to maintain complete client records across your systems.

Whether you're a therapist specializing in healthcare provider wellness, an EAP program serving medical institutions, or a group practice supporting physician mental health, this template provides the foundation for effective, empathetic intake that acknowledges the unique challenges physicians face.