Psychedelic-assisted therapy is emerging as a promising treatment for PTSD, depression, anxiety, and other mental health conditions. Whether you're conducting clinical research or offering therapeutic programs with MDMA, psilocybin, or other psychedelic compounds, thorough participant screening is essential for safety and efficacy.
This Psychedelic-Assisted Therapy Screening Form template helps mental health clinics, research institutions, and therapeutic centers evaluate potential participants systematically. The form covers critical medical exclusions, psychiatric history, current medications, cardiovascular health, and readiness for the unique psychological work involved in psychedelic therapy.
Built with Paperform, this template streamlines your intake process while maintaining the clinical rigor required for psychedelic medicine programs. Conditional logic adapts the screening based on participant responses, flagging contraindications and ensuring only appropriate candidates move forward. You can customize medical questions to match your specific protocol, connect responses to your practice management system, and use Papersign to collect required consent and liability waivers electronically.
Integration planning is just as crucial as the journey itself. This form includes sections for assessing support systems, therapeutic goals, and post-session integration resources—helping practitioners prepare participants for meaningful outcomes. For research teams, Stepper can automate follow-up scheduling, route approvals through ethics committees, and keep participant data synced with research databases.
Whether you're screening for clinical trials, ketamine-assisted psychotherapy, or legal psilocybin programs, this template provides a professional foundation that respects both the therapeutic potential and the medical responsibility inherent in psychedelic-assisted treatment.
More templates like this
Anxiety Disorder Diagnostic Assessment Form
A comprehensive clinical form for mental health professionals to assess anxiety disorder symptoms, including panic attack frequency, avoidance behaviors, and physical symptom presentation.
Bipolar Disorder Intake Form
Comprehensive intake form for bipolar disorder assessment, capturing mood episode history, medication trials, family psychiatric history, and current symptoms to support effective treatment planning.
Borderline Personality Disorder Assessment Form
A comprehensive clinical assessment tool for screening borderline personality disorder symptoms, including emotion dysregulation, relationship patterns, and behavioral indicators.
Collaborative Care Model Enrollment Form
A comprehensive enrollment form for integrated behavioral health programs combining primary care, psychiatric consultation, and care management services into a unified treatment approach.
Depression Screening & PHQ-9 Assessment Form
A comprehensive depression screening form featuring the standardized PHQ-9 questionnaire, risk assessment, and treatment history documentation for mental health professionals.
Early Psychosis Intervention Study Participation Form
A comprehensive research participation form for early psychosis intervention studies, capturing symptom onset timelines, medication consent, therapy inclusion preferences, and functional recovery goals.
Forensic Psychology Supervisor Wellness Check & Case Consultation Form
A comprehensive wellness assessment form designed for forensic psychology supervisors to conduct regular check-ins with trainees and staff, including case consultation support, risk evaluation, court testimony preparation, and ethical guidance.
Ketamine-Assisted Psychotherapy Screening Form
A comprehensive screening form for ketamine-assisted psychotherapy programs, evaluating treatment-resistant depression history, medical clearance requirements, and integration session planning for prospective patients.
Ketamine Therapy for Depression - Patient Intake Form
Comprehensive intake form for patients seeking ketamine therapy for treatment-resistant depression, including psychiatric history, medication trials, and safety screening.
Mental Health Counseling Office Lease Application
A specialized lease application for mental health professionals seeking office space with private therapy rooms, soundproofing, secure file storage, and crisis intervention facilities.
Mental Health Practice Management Software Request Form
Request form for mental health professionals seeking practice management software with progress notes, treatment planning, outcome measures, and teletherapy capabilities.
Psychosis Early Intervention Assessment Form
A comprehensive first-episode psychosis screening and coordinated specialty care enrollment form for mental health services, including clinical assessment, family education needs, and treatment planning.