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Social Services Client Intake Needs Assessment

A structured intake tool for social workers and case managers to capture a new client's presenting concerns, living situation, safety, and support network at first contact. An AI follow-up interview digs into the client's most urgent need in concrete detail so staff can prioritize referrals and flag anything requiring immediate safety follow-up.

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샘플 질문

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질문 13개 · 약 7분
Q01
메시지

Welcome, and thank you for taking a few minutes to share some information with us before your visit. Your responses are completely confidential and anonymized. There are no wrong answers here — this just helps your caseworker understand your situation and connect you with the right support. It takes about 6-8 minutes, and you can skip anything you're not comfortable answering.

Q02
객관식필수

What brings you in today? Select all that apply.

  • Housing instability or homelessness
  • Food insecurity
  • Financial hardship
  • Employment needs
  • Health or mental health concerns
  • Family or relationship issues
  • Domestic violence or safety concerns
  • Substance use support
  • Childcare needs
  • Legal issues
Q03
객관식필수

Which best describes your current housing situation?

  • Stable housing (own or rent)
  • Living with family or friends temporarily
  • Staying in a shelter
  • Staying outdoors, in a vehicle, or with no fixed address
  • Housing at risk (facing eviction or notice to vacate)
Q04
매트릭스필수

How urgent is each of the following needs for you right now?

6개 행 × 4개 열
  • Food
  • Housing
  • Healthcare access
  • Transportation
  • Childcare
  • 외 1개
열: Not a concern · Minor concern · Significant concern · Urgent - needs immediate help
Q05
의견 척도필수

Thinking about where you currently live, how safe do you feel there?

척도: 0 – 10
최소:Not safe at all최대:Completely safe
Q06
평점 척도

How would you rate the strength of your current support network (family, friends, community)?

범위: 1 – 5
최소:Very weak최대:Very strong
Q07
AI 인터뷰

Explore the need the respondent flagged as most urgent (housing, safety, food, income, etc.) in concrete, behavioral detail: what specifically is happening, how long it's been going on, and what they've already tried or who they've already contacted. If they indicated any domestic violence or safety concern, or rated home safety below 5, gently probe further and clearly note any disclosure that needs immediate follow-up per agency safety protocol, without pressuring them to disclose more than they're comfortable sharing. Close by asking what outcome would make this contact feel worthwhile to them.

Q08
단문형

In your own words, what would you like to see change or improve as a result of working with us?

Q09
객관식

Who do you currently turn to for support?

  • Family members
  • Friends
  • Faith community or place of worship
  • Support group or community organization
  • A case worker or counselor
  • Other
Q10
슬라이더 매트릭스

How confident are you in your ability to manage each of the following over the next 3 months?

4개 행, 각 행마다 슬라이더 1개
  • Financial stability
  • Housing stability
  • Physical health
  • Emotional wellbeing
슬라이더 0–10최소:Not confident at all최대:Extremely confident
Q11
드롭다운

What is your age range?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Prefer not to say
Q12
객관식

What is your current employment status?

  • Employed full-time
  • Employed part-time
  • Unemployed and looking for work
  • Unemployed and not looking
  • Retired
  • Unable to work due to disability
  • Student
  • Prefer not to say
Q13
메시지

Thank you for sharing this with us. Your caseworker will review your answers before your appointment so we can focus on what matters most to you and connect you with the right resources. If you disclosed a safety concern, a staff member may follow up with you directly.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

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이 템플릿을 선택하는 이유

  • Goes beyond a static intake form with an AI follow-up interview that digs into whichever need the client flags as most urgent (housing, safety, food, income) so staff get concrete, prioritized detail instead of a single checkbox answer.
  • Combines structured screening (multiple-choice presenting concerns, housing situation, a needs-urgency matrix, safety and support-network scales) with an open-ended short-text question so clients can describe in their own words what they want to change.
  • Includes a slider matrix on confidence managing near-term challenges plus demographic and employment context, giving caseworkers a fuller picture before the file even reaches review.
  • Frames the whole intake in a warm, transparent conversational flow — welcome and closing chat messages set expectations that a caseworker will review answers before follow-up.

Jotform

Social Worker Intake Form Template

A fielding-ready static intake form built on Jotform's drag-and-drop form builder, aimed at social workers collecting basic client information. It covers standard intake fields but relies on fixed questions rather than any adaptive follow-up. Good for quick deployment and integration with Jotform's wider form ecosystem (e-signatures, conditional logic, PDF export).

잘하는 점

  • Easy to customize using Jotform's drag-and-drop builder
  • Likely supports conditional logic, e-signatures, and PDF/report export common to Jotform templates
  • Fast to deploy for basic client intake data collection

아쉬운 점

  • No adaptive AI interview to probe deeper into a client's most urgent need — all questions are fixed at design time
  • No automated per-response quality scoring or transparent prompt methodology
  • No voice AI interview option for clients who prefer speaking over typing

Typeform

Social Worker Intake Form Template

A conversational-style, one-question-at-a-time intake template designed for a friendlier client experience than a traditional form. It's fielding-ready and benefits from Typeform's polished UI and logic-jump capabilities, but the questions themselves remain static and pre-scripted. There's no mechanism for the tool to dynamically dig deeper based on a client's specific answer.

잘하는 점

  • Polished, conversational one-question-per-screen interface that may feel less clinical to clients
  • Supports logic jumps to route respondents based on prior answers
  • Mobile-friendly design typical of Typeform templates

아쉬운 점

  • No adaptive AI follow-up interview — logic jumps are pre-set branches, not dynamic probing
  • No automated quality scoring of responses or safety-flagging based on open-ended detail
  • No voice AI interview option

SurveyMonkey

Client Intake Form Template

A general-purpose client intake template, not specific to social services, that would need significant customization to capture housing, safety, and support-network details relevant to case management. It's a standard static survey built on SurveyMonkey's broad platform, useful for basic contact and background info collection. It lacks any built-in structure for urgent-need triage or safety flagging.

잘하는 점

  • Backed by SurveyMonkey's mature survey infrastructure and reporting dashboards
  • Easy to customize question types and branding for general intake use
  • Familiar interface for respondents used to SurveyMonkey surveys

아쉬운 점

  • Generic client intake focus, not tailored to social-services needs like safety and housing urgency
  • No adaptive AI interview to explore a flagged urgent need in depth
  • No automated per-response quality scoring or transparent prompt disclosure

SurveySparrow

Sample client intake form template

This page reads more like a general client-intake template/category example than a purpose-built social services assessment, and its own title emphasizes 'printable intake forms,' suggesting a paper-first or generic-form orientation rather than a fielding-ready adaptive interview. It offers SurveySparrow's conversational form styling but is not tailored to case-management triage. Customization would be needed to add safety, housing, and support-network sections.

잘하는 점

  • Conversational, chat-like form styling consistent with SurveySparrow's product
  • Printable/exportable format may suit paper-based intake workflows
  • General template can be adapted across business use cases

아쉬운 점

  • Not purpose-built for social services intake — lacks native safety, housing-urgency, or support-network structure
  • No adaptive AI follow-up interview or voice AI option to explore urgent needs in depth
  • No automated quality scoring or transparent prompt methodology

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