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Social Worker Intake Form Template

Streamline Your Client Onboarding Process Effortlessly

Gathering essential client information can feel overwhelming, but our Social Worker Intake Form Template simplifies the process for you. Designed specifically for social workers, this template helps you efficiently collect vital details and ensure a smooth onboarding experience. Enjoy benefits like customizable fields for important data, HIPAA compliance options to protect client privacy, accessibility on all devices, and the ability to streamline your needs assessment process. Explore the live template to see its features in action.

Use this Template (FREE) Live Preview
Full legal name
Preferred name (if different)
Date of birth
If self-describe, please specify (optional)
Pronouns (optional)
Gender identity
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Email
Phone number
Mailing address
Preferred contact method
Phone call
Text message
Email
Video call
Postal mail
No contact preferred
Primary language
Interpreter needed
Yes
No
May we leave a detailed voicemail?
Yes
No
May we send text messages for scheduling/reminders?
Yes
No
Emergency contact full name
Relationship to you
Emergency contact phone
May we share scheduling information with this person?
Yes
No
Current living situation
Living alone
With partner or spouse
With family
With roommates
Temporary housing or shelter
Homeless or unsheltered
Residential facility
Prefer not to say
Other
Please Specify:
Number of people in your household
Number of dependents under 18
Any current custody or guardianship involvement?
Yes
No
Prefer not to say
Employment status
Primary income sources (select all that apply)
Please Specify:
How difficult is it to meet your basic expenses each month?
Very difficult
Difficult
Neutral
Easy
Very easy
Do you have a primary care provider?
Yes
No
Unsure
Provider or clinic name (if applicable)
Current medical conditions or disabilities we should be aware of
Are you currently receiving counseling or mental health services?
Yes
No
Prefer not to say
Substance use in the past 30 days (select all that apply)
None of the above
Alcohol
Tobacco or vaping
Cannabis
Prescription medication misuse
Opioids (non-prescribed)
Stimulants (e.g., cocaine, meth)
Hallucinogens
Other
Please Specify:
What brings you in today?
Your top priority in the next 30 days
Personal strengths and supports
Areas where you would like support (select all that apply)
Please Specify:
Do you feel safe where you live?
Yes
No
Unsure
Prefer not to say
Any immediate safety concerns today?
Yes
No
Prefer not to say
In the past 30 days, have you had thoughts of harming yourself or others?
Yes
No
Prefer not to say
Are there firearms or other weapons in the home?
Yes
No
Unsure
Prefer not to say
Preferred appointment times (select all that apply)
Weekday mornings
Weekday afternoons
Weekday evenings
Saturday
Sunday
No preference
Preferred session format
In person
Phone
Video
No preference
Accessibility accommodations needed (select all that apply)
Mobility access
Hearing accommodation
Vision accommodation
Cognitive or learning support
Quiet environment
Service animal accommodation
None
Other
Please Specify:
I consent to the collection and use of my information for service coordination
Yes
No
I consent to communicate with my emergency contact about scheduling
Yes
No
Signer full name
Signer relationship to client
Signature
Date
I have received and reviewed the notice of privacy practices
Yes
No
Not applicable
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Paper art illustration depicting a social worker intake form for FormCreatorAI article

When to use this form

Use this form at first contact, such as walk-ins, hotline referrals, home visits, school meetings, or hospital discharge. This social work intake form captures presenting concerns, risks, strengths, demographics, and consent in one pass, so you can triage, set goals, and plan services. If you are onboarding a client more broadly, pair it with the Client intake form. For behavioral health needs, route clinical details to the Mental health intake form. After enrollment, manage referrals, tasks, and follow-ups with the Case management form. The result: consistent records, faster safety checks, and clearer next steps for you and your team.

Must Ask Social Worker Intake Questions

  1. What brought you to seek support today, and what change would you like to see in the next 30 to 60 days?

    This surfaces the presenting issue and sets a short-term goal, which guides priorities and your care plan. Clear goals make it easier to measure progress and align expectations.

  2. Do you have any immediate safety concerns for yourself or others, including self-harm, abuse, or unsafe housing?

    Safety triage ensures urgent risks are addressed before anything else. It informs crisis planning and required reports, protecting you and others.

  3. Who lives in your household, and who do you rely on for support?

    Knowing household members and key supports shows responsibilities, caregivers, and stressors. It helps identify natural supports and any consent needs.

  4. What services, benefits, or providers are you currently working with, and may we coordinate with them?

    Understanding active services prevents duplication and gaps. With your permission, coordination and referrals are tracked more cleanly in the Case management form.

  5. What languages, cultural practices, or accessibility needs should we honor, and how do you prefer we contact you?

    These details reduce barriers and build trust from the start. Your chosen channel also enables quick follow-ups using a Session check-in form.

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