Patient Interview Screener and Consent Template

A patient interview screener and consent template does two jobs: a short set of qualifying questions that confirm you're talking to someone who actually has the condition or situation you're researching, and a plain-language script you read aloud before the conversation starts — who you are, why you're asking, and that nothing they say commits them to anything. Below is both, copy-paste ready, with the reasoning behind each field so you can adapt it instead of using it blind.

Quick Answer: Screen with 4-6 questions that confirm condition, tenure, and current behavior — not agreement with your idea. Then read a short consent script before the interview: who you are, why you're asking, that it's voluntary, how you'll use what they say, and whether you're recording. This is a plain-language transparency template for informal product-discovery conversations, not IRB-grade research consent. If your work is, or might become, a formal research study, you need actual IRB guidance, not this article.

That distinction matters more than any single line of wording in the template itself. A screener and consent script for informal customer-discovery interviews — the kind you run to learn whether a product idea holds up before you build it — is not the same process as the informed-consent documentation a clinical trial or any study reviewed by an Institutional Review Board (IRB) or ethics committee requires. IRB review exists for research that tests an intervention, collects data intended for publication or a regulatory submission, or involves procedures with real risk to participants, and it runs on a stricter, legally defined process this template does not attempt to replace. If you're recruiting through a health system, testing a clinical intervention, or planning to publish or submit findings, stop and get real IRB guidance before you interview anyone. Everything below is written for the earlier, informal stage: talking to patients the way you'd talk to any prospective customer, being straightforward about who you are and why you're asking.

That earlier stage still needs structure. Patients are one of several stakeholders a health product usually has to satisfy, and it's worth knowing early whether the patient in front of you is the buyer, the user, or both — our breakdown of who actually pays in digital health, provider, patient, or payer covers that split and shapes which screener questions below matter most for your idea. And if you haven't found anyone to screen yet, recruiting research participants from patient communities is the piece to read first — this template assumes you already have someone on the line.

The Template: Screener Questions and Consent Script

Use the template in sequence, not in parallel: screen first, over email or a quick message, so you don't spend 20-30 minutes with someone who doesn't fit. Then read the consent script at the start of the call itself, before you ask a single real question.

Screener questions. Send these ahead of scheduling, or ask them in the first two minutes of a call before you commit either of your time to the full conversation.

Consent script. Read this, or closely paraphrase it, at the start of every interview, before you start recording or taking substantive notes.

"Thanks for making time. Before we start, I want to be upfront about what this is. I'm [your name], and I'm looking into [problem area] — right now I'm just trying to understand how people actually experience this, not selling you anything or testing a finished product.

This isn't a clinical study, and nothing we talk about goes into any medical record. I'm not a doctor, and nothing I ask — or say — should be taken as medical advice.

Talking to me is completely voluntary. If a question feels too personal, just say so and we'll skip it. You can also stop the conversation entirely at any point, no explanation needed.

[If recording:] I'd like to record this so I'm not scribbling notes while we talk. The recording is just for me to review later — is that okay? [Wait for a clear yes before you start.]

What you tell me might inform decisions about a product, but I won't share your name or anything that identifies you outside my own notes, and I won't quote you publicly without checking with you first.

Any questions before we start?"

Why Each Field Is There

Every line in the screener and script is doing a specific job. Cutting a question or softening the consent language usually reintroduces the exact risk it was written to close.

The condition-or-caregiver question exists because "interested in the topic" and "lives with the condition" are different populations, and only one of them can tell you what actually happens day to day. A polite acquaintance who read an article about the condition will give you opinions; someone managing it will give you behavior.

The tenure question filters recency. Someone diagnosed last week is still forming an opinion, not describing an established pattern — useful for a different kind of research, but not for understanding entrenched workarounds.

The decision-network question surfaces who else actually influences the decisions you care about. A patient might be the one experiencing the problem while a caregiver or clinician controls the budget or the final call — missing that split is one of the more common ways founders misread patient interviews as stronger buying signal than they are.

The current-solution question is the one place this template leans hardest on established interview practice. It follows the core rule from Rob Fitzpatrick's The Mom Test: ask what someone actually does today, not whether they'd like a hypothetical product. "Nothing structured" or "I tried an app and stopped" is a stronger, more actionable signal than polite enthusiasm for a feature you haven't built yet, because it points directly at where the friction lives.

The availability question is logistics, not research — but skipping it is how founders end up with a 20-minute conversation crammed into someone's 8-minute gap between appointments, which produces thin, rushed answers.

The accessibility question is a respect issue as much as a data-quality one. Asking upfront, rather than discovering mid-call that a video format doesn't work for someone, keeps the conversation from becoming a burden on the person doing you a favor.

On the consent side, the opening framing ("not selling you anything, not a finished product") matters because it sets the right expectation immediately — a patient who thinks they're evaluating a real product will answer differently than one who knows they're helping you think. The "not a doctor, not medical advice" line is the one addition a patient interview needs that a generic customer interview doesn't: health topics make it easy for a patient to slip into treating you as a source of guidance, and it's on you to close that gap before it opens. The voluntary/right-to-stop line is the actual substance of informal consent — permission that can be withdrawn at any point is worth more than a signature obtained once. The explicit recording question matters because showing up to a call is not consent to be recorded; you need an affirmative yes, not silence. The data-use line sets expectations before you ever write up findings, so nobody is surprised later by how their words get used.

Filled Example: Screening for a Chronic-Condition App Idea

Here's the template filled in for a hypothetical idea: an app that helps people managing type 2 diabetes track blood sugar patterns between doctor visits. This is illustrative only — swap in your own condition, product, and phrasing before you use it.

• "Do you currently have type 2 diabetes, or care for someone who does?" — You're looking for a yes tied to personal or caregiving experience, not "I read something about it."
• "About how long have you been managing this?" — Under six months is often too early to have working habits worth learning from; over a year usually is not.
• "What are you currently using to track your blood sugar — an app, a paper log, your meter's built-in memory, nothing structured?" — An answer of "nothing structured" or "I used to, but stopped" is frequently the most useful group to talk to, because it points straight at the friction. This is the Mom Test principle from the section above, applied directly: you're screening for behavior, not for whether the idea sounds appealing.
• "Would 20-30 minutes work, with nothing to prepare?" — Confirms they can actually commit before you spend a scheduling round-trip on someone who can't.

The consent opening, adapted for this idea, would start: "Thanks for making time. I'm looking into how people managing type 2 diabetes keep track of their blood sugar day to day — I'm not selling anything, and this isn't part of your care team's records. Nothing we discuss is medical advice, and you can skip any question or stop at any point..." — the rest of the script runs unchanged. Once you've run enough of these conversations to need a repeatable structure for the interview itself, not just the screening and consent around it, the complete guide to customer research for founders covers how to build and sequence the actual question set.

Casual Chat vs. Consented Interview: When Each Is Appropriate

Not every conversation with a patient needs the full script — but the two formats aren't interchangeable, and using the wrong one has a real cost either way: a casual chat treated as evidence is unreliable, and a fully scripted consent process run on every five-minute hallway question wastes goodwill you'll need later.

In practice, default to the consented version the moment a conversation stops being a hallway chat and starts being something you'll act on. Screening calls can stay casual; the interview itself usually shouldn't.

Key Takeaways

• Screen before you schedule, not during the call. A 4-6 question screener confirms condition, tenure, and current behavior before either of you spends 20-30 minutes on a mismatch.
• Consent is a spoken script, not a form nobody reads. Read it, or closely paraphrase it, at the start of every interview, every time — not just the first one.
• "Not medical advice, not part of any medical record" is the one line patient interviews need that other customer interviews don't. Say it early, before anyone can mistake you for part of their care team.
• Get an explicit yes before recording. Showing up to the call is not consent — silence isn't either.
• This is a transparency template, not IRB approval. The moment your work becomes, or might become, a formal research study, this template stops being sufficient and real IRB guidance becomes necessary.
• Screen for behavior, not enthusiasm. Per The Mom Test, "what are you using right now" beats "would you use an app for this" every time.
• Casual exploratory chats and consented interviews are different tools. Reserve the full script for any conversation you intend to record, quote, or treat as evidence.

Frequently Asked Questions

Do I need IRB approval to interview patients for a startup idea?

Generally no, if you're having informal discovery conversations about a product idea rather than running a formal research study. IRB review exists for research that tests an intervention, targets publication or a regulatory submission, or carries genuine risk to participants. If there's any real chance your work fits that description, don't guess — get actual IRB guidance before you interview anyone.

What should I say to a patient before a customer discovery interview?

Cover six things: who you are, why you're asking, that participating is voluntary, that this isn't medical care or advice, whether you're recording (with an explicit yes), and how you'll use what they say. The consent script above covers all six in under 30 seconds of speaking.

Can I record patient interviews for informal research?

Yes, once you've explicitly asked and received a clear yes — never start recording on the assumption that showing up to the call is consent. State what the recording is for and how you'll use it, and if the answer is no, take notes instead rather than pushing.

How is a patient interview different from a regular customer interview?

Mechanically they're similar: screen for real experience, get consent, ask about behavior rather than opinions. Patient interviews add one disclosure a generic customer interview doesn't need — an explicit statement that you're not part of the person's care team and nothing you say is medical advice, since the health context makes that assumption easy to slip into by accident.