Individual Intake Questionnaire
Please read this carefully before purchasing. By completing a purchase from this shop, you acknowledge that you have read, understood, and agreed to all terms below.
1. Nature of Products
All products sold in this shop are digital template documents intended for use by licensed mental health clinicians in the United States. They are educational and professional resources designed to serve as a starting point for practice documentation. They are not finished legal documents, clinical instruments, or compliance guarantees. They are not a substitute for professional legal advice, clinical supervision, or state-specific regulatory guidance.
2. No Legal or Clinical Advice
Nothing in these templates or accompanying materials constitutes legal advice, clinical advice, or a professional opinion about any specific situation. Purchase of a template does not create an attorney-client relationship, a supervisory relationship, or any other professional relationship between the purchaser and the creator of these materials. For guidance specific to your practice, jurisdiction, or clinical population, consult a licensed attorney, your licensing board, and/or your malpractice insurance carrier.
3. Purchaser Responsibility
You, the purchaser, are solely responsible for:
Accepting full legal, clinical, and ethical responsibility for these materials at the moment of download or access, including all decisions made about their adaptation, distribution, and use
Reviewing and customizing all templates before use
Ensuring all documents comply with the laws and regulations of your state and jurisdiction
Obtaining appropriate legal and professional review before distributing any document to clients
Using all templates within your scope of licensure and clinical competence
Ensuring that supervised providers, interns, or residents using these templates do so under appropriate clinical oversight
Updating documents as laws, regulations, and your practice structure change over time
3a. Transfer of Responsibility Upon Download
By downloading or accessing any product from this shop, you accept full and sole responsibility for that document and all uses of it from that moment forward. The act of downloading constitutes your acknowledgment that you have read and agreed to these terms, that you understand the template requires customization and professional review before use, and that the creator of these materials bears no responsibility for any outcome arising from your use, adaptation, or distribution of the document—regardless of whether it has been reviewed, modified, or used as-is.
No refund, claim, or dispute can undo the transfer of responsibility that occurs upon download.
4. No Warranty
These templates are provided "as is." No warranty, express or implied, is made regarding their fitness for any particular purpose, their compliance with any specific state or federal law, or their suitability for any specific clinical population or practice setting. The creator of these materials makes no representation that these documents will protect you from licensing complaints, malpractice claims, regulatory penalties, or any other adverse outcome.
5. Limitation of Liability
To the fullest extent permitted by applicable law, the creator of these materials shall not be liable for any direct, indirect, incidental, consequential, or punitive damages arising from the purchase, use, misuse, or inability to use these templates—including but not limited to licensing complaints, malpractice claims, regulatory actions, client harm, or any other professional or legal consequences resulting from the use or adaptation of these materials.
By purchasing and using these templates, you agree that your sole remedy for any dissatisfaction with a product is to discontinue use of that product.
6. Scope of Use
These templates are licensed for use by the individual purchaser only. They may not be resold, redistributed, shared publicly, published, or used to create derivative products for sale without explicit written permission from the creator. Use within a single practice—including by multiple clinicians within that practice—is permitted.
7. Healthcare and Mental Health Context
These templates are designed for use in mental health and behavioral health settings and involve sensitive clinical content including, but not limited to, safety screening, trauma history, substance use, identity, and informed consent. The purchaser acknowledges the sensitive nature of this content and assumes full responsibility for the clinical and ethical appropriateness of any document they distribute to clients.
8. Refund Policy
Due to the digital nature of these products, all sales are final once a file has been downloaded or accessed. No refunds will be issued except in the case of a verified technical failure preventing access to a purchased product. If you experience a technical issue, contact us at [EMAIL] within 7 days of purchase and we will resolve it promptly.
The act of downloading or accessing a purchased file constitutes acceptance of full responsibility for that document. No refund, claim, or dispute alters the transfer of responsibility that occurs at the moment of download.
9. Governing Law and Jurisdiction
These terms are governed by the laws of the District of Columbia. Any disputes arising from the purchase or use of these products shall be resolved in the courts of the District of Columbia. However, because these templates may be purchased and used by clinicians located in any state or jurisdiction, purchasers are solely responsible for ensuring that their use of these materials complies with the laws and regulations of their own state, jurisdiction, and licensing board. The governing law of these terms does not imply that these templates have been verified for compliance in any jurisdiction other than as noted in the templates themselves.
10. Updates to Terms
These terms may be updated periodically. The version in effect at the time of purchase governs your transaction.
11. Geographic Scope and Jurisdictional Responsibility
These templates are designed for use by licensed mental health clinicians in the United States. They reflect federal standards under HIPAA and general best practices in the mental health field. They are not designed for use outside the United States and make no representation about compliance with international law or the laws of any non-U.S. jurisdiction.
Within the United States, mental health licensing, telehealth regulation, informed consent requirements, minor consent laws, confidentiality protections, and recordkeeping requirements vary significantly by state and may change over time. It is the purchaser's sole responsibility to ensure their finalized documents comply with the laws of their specific state and jurisdiction. The creator of these materials is located in Washington, DC and makes no representation that these templates satisfy the requirements of any specific state outside of general federal compliance.
Due to the digital nature of these products, all sales are final once a file has been downloaded or accessed. No refunds will be issued except in the case of a verified technical failure preventing access to a purchased product. If you experience a technical issue, contact us at [EMAIL] within 7 days of purchase and we will resolve it promptly.
The act of downloading or accessing a purchased file constitutes acceptance of full responsibility for that document. No refund, claim, or dispute alters the transfer of responsibility that occurs at the moment of download.
The act of downloading or accessing a purchased file constitutes acceptance of full responsibility for that document. No refund, claim, or dispute alters the transfer of responsibility that occurs at the moment of download.
This template is designed for adaptation, not verbatim use. It is not a finished legal document and does not constitute legal advice. These templates reflect federal standards and general best practices—they are not pre-verified for any specific state. You are responsible for ensuring compliance with the laws of your jurisdiction. Before distributing to clients, have your final version reviewed by your licensing board, malpractice carrier, and/or a licensed attorney. By downloading this template, you accept full responsibility for its customization, review, and use. The creator of these materials bears no responsibility for any outcome arising from your use of this document from the moment of download forward. By purchasing, you agree to our full Terms of Sale and Liability Disclaimer.