Q01
Message
All templates
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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
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
Multiple ChoiceRequired
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
MatrixRequired
How urgent is each of the following needs for you right now?
6 rows × 4 columns
- Food
- Housing
- Healthcare access
- Transportation
- Childcare
- +1 more
Columns: Not a concern · Minor concern · Significant concern · Urgent - needs immediate help
Q05
Opinion ScaleRequired
Thinking about where you currently live, how safe do you feel there?
Scale: 0 – 10
Min:Not safe at allMax:Completely safe
Q06
Rating Scale
How would you rate the strength of your current support network (family, friends, community)?
Range: 1 – 5
Min:Very weakMax:Very strong
Q07
AI Interview
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
Short Text
In your own words, what would you like to see change or improve as a result of working with us?
Q09
Multiple Choice
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
Slider Matrix
How confident are you in your ability to manage each of the following over the next 3 months?
4 rows, one slider each
- Financial stability
- Housing stability
- Physical health
- Emotional wellbeing
Slider 0–10Min:Not confident at allMax:Extremely confident
Q11
Dropdown
What is your age range?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q12
Multiple Choice
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
Message
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.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- 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 TemplateA 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).
What it does well
- 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
Where it falls short
- 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 TemplateA 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.
What it does well
- 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
Where it falls short
- 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 TemplateA 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.
What it does well
- 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
Where it falls short
- 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 templateThis 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.
What it does well
- 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
Where it falls short
- 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
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.