Free Doxy.me Telehealth Session Intake Template

What is a telehealth session intake?

A telehealth session intake is a brief structured checklist completed at the beginning of a telehealth appointment to verify essential safety and logistical information before the clinical session begins. Unlike an initial intake assessment (which is comprehensive and conducted once), a session intake is completed at each telehealth appointment to confirm: the person on the video is the client (identity verification), the client is in a safe and private location, emergency contact information is current, technology is functioning properly, and specific consents (recording, if required by jurisdiction) are documented. A telehealth session intake protects both clinician and client: it ensures the clinician is speaking with the actual client (not someone else using their account), confirms the client has privacy for the conversation, verifies working technology before beginning the session, and documents compliance with recording consent laws. When using Doxy.me, Scriber's direct integration captures session audio automatically while your call runs in Scriber, so the session intake also confirms the client understands audio capture and consents to it.

What's in this template

This Doxy.me-specific session intake template includes:

• Session Date & Time: Date of session, time session began, client name and patient ID
• Identity Verification: Confirmation that the client on video matches the chart photo or ID, verification method used (asked for birthdate, asked for last 4 of SSN, reviewed ID on camera, etc.), clinician initials confirming verification
• Location & Privacy Check: Client confirms they are in a private space with a door that can close (or at minimum out of earshot of others), no one else present who can hear the conversation, client feels safe and comfortable in the location, clinician observes no concerning background or safety issues
• Emergency Contact Verification: Current emergency contact name and phone number confirmed or updated, client confirms this person knows they can be contacted in case of crisis, backup emergency contact if primary is unavailable
• Technology Check: Client confirms stable internet connection, camera and microphone working properly, audio/video quality adequate for session, client's device is charged or plugged in, no known technical issues anticipated during the session
• Recording & Data Capture with Scriber Integration: Client acknowledges that Scriber's direct Doxy.me integration captures session audio while the call runs in Scriber (no additional recording button to press — it's automatic), explains that captured audio helps Scriber's AI generate a draft transcript and note summary, confirms client consents to this audio capture, explains how the transcript and notes will be used (clinical documentation, clinician review, part of the medical record), clarifies that the transcript is stored securely and subject to same confidentiality protections as session notes, documents jurisdiction-specific recording consent requirements (some jurisdictions require explicit consent; this intake documents that consent)
• Confidentiality Reminder: Brief reminder of confidentiality limits specific to telehealth (not a secure method if others have access to the client's device), reminder about avoiding PHI in background or visible materials, reminder about not taking screenshots or recording on the client's end without clinician permission
• Session Agenda Check-In: Anything urgent or crisis issues the client needs to address first, any new safety concerns since last session, what the client most wants to focus on in today's session
• Technical Support During Session: What the client should do if technology fails during the session (call back, wait for clinician to reconnect, text to confirm connection status)
• Client Signature or Verbal Acknowledgment: Client confirms they have reviewed and agree to all items above, verbal acknowledgment documented by clinician initials, option for client to sign electronically if using a form platform
• Clinician Signature & Date: Clinician initials and dates to confirm all items were reviewed

When to use this template

Use the Doxy.me session intake when:

• Beginning a telehealth appointment via Doxy.me
• Seeing a client for the first time on Doxy.me to establish baseline safety protocols
• Resuming telehealth sessions after a break to re-verify current status
• Starting each session to ensure updated emergency contact information and confirm privacy
• Documenting compliance with recording consent requirements in your jurisdiction
• Establishing a routine practice of safety verification that becomes normalizing and quick for ongoing clients

This template is used by any mental health clinician (therapists, counselors, psychologists, psychiatrists, nurses) providing sessions via Doxy.me or other telehealth platforms.

How to use the template with Scriber

Start each Doxy.me telehealth session by reviewing this intake checklist with the client — it typically takes 2-3 minutes. Scriber's direct Doxy.me integration automatically captures the audio of the entire session, including this intake checklist and the clinical work that follows. You don't need to click a recording button; Scriber captures the audio seamlessly while your call runs in Doxy.me. As you review each item on the intake checklist, the client confirms understanding, and you document their acknowledgment. Once the intake is complete and you're confident the client is in a safe, private location with proper consent for Scriber's audio capture, you proceed with the clinical session. After the session ends, Scriber's AI generates a transcript and draft clinical note from the captured audio. You review the draft (which will include the session intake conversation), edit it for accuracy, integrate it into your clinical documentation system, and sign the note. This approach ensures every session begins with documented safety verification while Scriber handles the transcription burden.

Download (free)

This template is available as a printable PDF and editable DOCX file. You can print a fresh copy for each session (quick and low-tech) or use an electronic form that clients complete on their end before or during session startup. Customize it to match your specific Doxy.me setup, add any local or jurisdiction-specific recording consent language required in your state, and use it as a standard intake for every Doxy.me session. Some clinicians keep a paper checklist in front of them during sessions; others use it as a mental checklist once they've done it enough times to make it routine.

[Download PDF]

Related templates

• Telehealth Informed Consent — Comprehensive form for consenting to telehealth services
• SOAP Note Template — Standard progress note format for clinical documentation