Upheal alternative
An Upheal alternative for therapists whose audio shouldn't leave the room
Upheal is one of the strongest products in the 2026 therapy-tech market for clinicians who want video telehealth and AI notes wired together in one place. TherapyDraft is the opposite shape: a Mac app that listens to in-person session audio through your microphone and drafts the note locally — no video, no cloud, no upload. The two products optimise for different practice patterns. This page is for clinicians figuring out which pattern is theirs.
TL;DR
Upheal is an all-in-one cloud platform: it hosts the video telehealth call AND drafts the note from the same recording. TherapyDraft is a focused on-device tool: a Mac app that converts microphone audio to a SOAP/DAP/BIRP/GIRP draft entirely on your hardware. If most of your sessions are video telehealth and you want one vendor doing both pieces, Upheal is the cleaner choice. If most of your sessions are in-person (or audio-only telehealth) and you'd rather your session audio never leave the device it was recorded on, TherapyDraft is the answer.
Why therapists compare Upheal and TherapyDraft
The comparison comes up most often in three scenarios:
- Your caseload shifted post-pandemic. You started Upheal in 2022 when 80% of sessions were on Zoom, and now 70% are in-person again. Paying for a video-host platform you barely use is friction; you want a scribe that records the room, not a separate webcam stack you don't need.
- You're choosing between scribes for the first time. Both names came up in the same clinician thread. You don't run video sessions through Upheal — you use a separate telehealth platform (SimplePractice, doxy.me, Zoom for Healthcare) — so Upheal's main differentiator is wasted on you.
- Your malpractice carrier or compliance officer flagged the cloud upload. Upheal's BAA is well-drafted and their security posture is genuinely competent, but the audio still leaves your network. For a clinician working with a high-stakes population (forensic, custody-evaluation, public-figure), a "the audio stays on the Mac that recorded it" architecture removes a category of question entirely.
If none of these apply — if you're a video-first practice that wants one vendor in the loop — Upheal is the simpler answer and we'll say so.
How TherapyDraft is different
Upheal's pipeline is designed around video sessions hosted on Upheal's own platform. The audio and video stream to Upheal's servers as part of running the call, transcription happens server-side, the note is drafted by a cloud LLM, and the result is returned to your dashboard. The BAA covers all of this and Upheal's privacy documentation is explicit about each subprocessor in the chain.
TherapyDraft doesn't host video at all. It listens to whichever microphone you tell it to — your Mac's built-in mic for an in-person session, or a virtual audio device piping in your existing telehealth platform's audio for a remote session. Transcription runs locally via whisper.cpp, the Apple-Silicon-optimised port of OpenAI's Whisper family. Drafting runs locally via a 4-bit-quantized Qwen 2.5 14B model on Apple's MLX runtime. The Mac app's network entitlements are restricted at the macOS sandbox level to two hosts: Stripe (license activation) and our update server (version checks). The audio file and the draft never traverse a network socket. You can verify this in Activity Monitor's Network tab during a session — bytes-out stays at near-zero throughout the recording.
The trade-off is honest: TherapyDraft does one thing (drafts a clinical note from audio you control). Upheal does that plus runs the call. If you want both, Upheal is more efficient. If you only want the first, TherapyDraft does it without the surface area of the second.
Side-by-side comparison
| Upheal | TherapyDraft | |
|---|---|---|
| Primary use case | Video telehealth + AI notes, integrated | AI notes from in-person or audio-only sessions |
| Hosts the video call | Yes (built-in telehealth platform) | No — bring your own platform or in-person mic |
| Where transcription runs | Upheal cloud | Your Mac (whisper.cpp, local) |
| Where drafting runs | Upheal cloud (LLM provider) | Your Mac (Qwen 14B 4-bit on MLX, local) |
| Session audio leaves your device | Yes (uploaded as part of the call) | No (blocked by macOS sandbox entitlements) |
| HIPAA posture | Signed BAA with Upheal | No BAA needed — no PHI is transmitted |
| Subprocessor chain for PHI | Video infra + speech model + LLM + storage | None — zero subprocessors touch audio or text |
| Works offline | No (cloud-hosted call) | Yes (in-person sessions; flight mode supported) |
| Note formats | SOAP, DAP, BIRP, GIRP, intake, treatment plan | SOAP, DAP, BIRP, GIRP (v1) |
| EHR paste presets | Standard copy-paste | Per-EHR presets (SimplePractice, TheraNest, TherapyNotes, Jane) |
| Tamper-evident receipt | Server-side audit log | Hash-chained JSONL on your disk |
| Platform | Web (any device with browser) | macOS 14+ on Apple Silicon (M1–M4) |
| Price | From $29/mo (Starter); $49/mo (Pro tier at 2026 rates) | $39/mo or $349/yr — flat, unlimited |
| Free trial | Limited sessions | 10 sessions, no credit card |
Video-first vs audio-first: which is your practice?
The cleanest way to decide is to ask one question: where do most of your sessions actually happen?
- Mostly video, single platform. If 60% or more of your caseload is video and you want the call host and the note tool to be the same vendor, Upheal is the right answer. You get one BAA, one bill, one dashboard, one place to look when something breaks.
- Mostly in-person. If you see clients in your office and the audio you care about is the room, you don't need a video host — you need a microphone listener. TherapyDraft is built for the room. Set the Mac on the side table, hit record on the menu bar, do the session, hit stop.
- Mixed but on a separate telehealth platform. If your video runs through SimplePractice, doxy.me, or Zoom for Healthcare and you don't want to migrate, the question is which scribe to bolt on. Upheal works as a scribe-only product but its strongest features are wasted; TherapyDraft attaches via a virtual-audio device and gets you the architectural wedge with no migration.
The wrong shoe-horn — using Upheal with no video, or using TherapyDraft to drive a video call — works but leaves value on the table in either direction.
When Upheal is still the right choice
- Video is your platform. If you're running calls through Upheal today and the integration is working, switching to a scribe-only product loses the all-in-one efficiency. Stay.
- You're not on a Mac. TherapyDraft is Apple-Silicon-only in v1. If your primary computer is Windows or a Chromebook, Upheal's web app is the answer.
- You move between machines often. Upheal works on any browser. TherapyDraft is tied to the Mac it's licensed on (a second seat exists but isn't free).
- You need specialty templates on day one. Upheal's library covers intake, treatment-plan, and group templates in v1. TherapyDraft ships the four core progress-note formats and adds more per customer demand.
- You're price-sensitive at the entry tier. Upheal Starter is $29/mo if you fit the lower session cap; TherapyDraft is a flat $39/mo for unlimited. For a part-time caseload (under ~30 sessions/mo) Upheal Starter is cheaper.
Trying TherapyDraft without leaving Upheal
If your caseload is mixed and you want to test, the low-risk pattern is: keep Upheal for the video sessions you're already running on it, and run TherapyDraft on your in-person sessions during the 10-session free trial. Compare the drafts for clinical utility and compare the minutes you spend editing each. No credit card, no sales call. After the trial, decide whether your practice benefits more from "one vendor, all the data in the cloud" or from "two narrow tools, neither of which holds the audio."