Get Social Work Intake Form

Filling out the Social Work Intake Form online is an important step in accessing the support you need. This guide will provide clear instructions to help you navigate each section of the form with ease.

Follow the steps to successfully complete your online form

1. Click the ‘Get Form’ button to obtain the Social Work Intake Form and open it in your preferred editor.
2. Begin by entering the date at the top of the form. This helps document when you filled out the form.
3. Complete the personal information section by clearly writing your full name, address, city, state, and zip code.
4. Provide your contact information, including your home phone number and cell phone number. Indicate whether you would like to be contacted at work, and if so, list your work phone number.
5. Fill in your social security number, date of birth, age, sex, and marital status.
6. Indicate who you are currently living with by checking the appropriate box (e.g., parents, spouse, roommate, alone, or other). If applicable, provide your spouse’s name and the duration of your marriage.
7. If divorced, provide the time since your divorce and the length of any previous marriages.
8. List your occupation, your employer, and the average number of hours you work per week. If you are a student, specify your school or university and whether you are a full-time or part-time student.
9. Identify who will be responsible for the payment of your bill and their relationship to you. If their address is different, provide that as well.
10. Indicate if you will be using insurance by answering yes or no. If yes, include the details about your primary insurance company, including your policy ID number, group number, and policyholder information.
11. Indicate your education level by checking the relevant boxes: elementary school, high school, college, or other.
12. Provide information about your religious denomination or church affiliation, and specify if you are currently active or inactive.
13. On the back of the form, describe any physical problems requiring medication or care, and list any current medications you are using.
14. State whether you are receiving medical treatment and provide the name of your physician or healthcare provider.
15. Indicate if you have previously undergone therapy or hospitalization and provide the relevant details including where, with whom, and the dates.
16. In the designated section, check any problem areas that concern you and provide additional comments if necessary.
17. Describe the main problem that prompted you to seek therapy and note any additional information you feel is important for your therapist to know.
18. After completing the form, review it for any errors or omissions. You can then save your changes, download, print, or share the form as needed.

Complete your Social Work Intake Form online today to take the first step towards getting the support you need.