Beneficiary Intake Form
Register someone for support with dignity, asking only what a service genuinely needs and letting them decline any question.
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Opens in the builder. Nothing is saved until you edit it.
- Fields
- 13 questions
- Theme
- Ocean, switchable in the preview
- Updated
- 11 August 2026
Categories
- Nonprofit
- Nonprofit Forms
- Intake Forms
- Referral Forms
Ideal for
- Charities
- Food banks
- Advice services
- Support workers
Best used in
- Service referrals
- Support intake
- Crisis response
About this template
An intake form for someone asking for help is the first impression a service makes, and most of them read like an eligibility test. This one asks what would help before it asks anything about circumstances, and the situation field says in its placeholder that you do not have to answer it to get help.
The contact preference question includes going through a support worker, which matters for people who share a phone or have no private space to take a call. Getting this wrong is one of the more common reasons a referral goes cold after the first attempt.
Urgency is asked directly rather than inferred, because a service that reads need help today as routine has failed at the first step. Keep the household questions optional with a prefer not to say option, and set a short retention period, since this is some of the most sensitive data a form can hold.
Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.
Fields in this template
- Name you would like us to use*Short text
- Best number to reach youPhone
- Email addressEmail
- How should we contact you?*Single choice
- Which of these would help?*Multiple choice
- Tell us as much or as little as you want about your situationLong text
- How urgent is this?*Single choice
- Who lives with you?Dropdown
- How many children under 18?Number
- How did you hear about us?Dropdown
- Which language would you prefer?Short text
- Anything we should arrange so you can access our service?Long text
- Consent*Multiple choice
Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.
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