---
title: Psychedelic-Assisted Therapy Screening Form Template | MDMA & Psilocybin Research Intake | Paperform
description: Comprehensive screening form for psychedelic therapy programs. Assess medical exclusions, psychiatric history, and integration readiness for MDMA or psilocybin-assisted treatment and research.
url: "https://paperform.co/templates/psychedelic-assisted-therapy-screening-form"
type: static
generatedAt: "2026-03-28T00:44:56.918Z"
---

[← Back to free form templates](/templates/)    ![Psychedelic-Assisted Therapy Screening Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/psychedelic-assisted-therapy-screening-form.png)
    [Preview](https://_preview.paperform.co/ai-template/psychedelic-assisted-therapy-screening-form) [Use this template for free](/create?ai-template=psychedelic-assisted-therapy-screening-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/) [Therapist](/templates/role/therapist/)[Counselor](/templates/role/counselor/)[Psychologist](/templates/role/psychologist/)[Researcher](/templates/role/researcher/)     About this free form template
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.
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