Social Services Client Intake Template
Collects contact preferences, household and housing details, income range, language needs, and requested support for social service teams conducting client intake.
When to use it
- At a first appointment with a social services agency
- When referring someone for food, housing, or legal support
- When a client needs to share safe contact instructions
- When updating household or language needs
What it asks
- What is your name?
- What phone number can we use to reach you?
- What email address can we use to reach you?
- What is the safest way for us to contact you?
- Is there a safe time or any contact instructions we should know?
- It’s safe to leave you a voicemail or message.
- Who lives in your household?
- Which best describes your housing situation?
- What is your approximate monthly household income?
- What support are you looking for?
- Is there anything else you need help with?
- What language or languages do you prefer for services?
Why it should be encrypted
Contact details, income, housing circumstances, and requests for help can expose a client's private situation. Answers are encrypted in the respondent's browser so only people with authorized access should read them—not unrelated parties or SealForm.
Tips
- Explain who will review responses and how the team will follow up.
- Make the safe contact method and instructions easy to find.
- Adjust support options and languages to match the services you offer.