Sample Client Intake Form

A sample client intake from from Meals On Wheels, Inc. of Tarrant County (MOWI).  MOWI has been utilizing basic evidence based screening tools but has very recently expanded its screening process to include other evidence based screening tool to better assess clients’ need and health risks.

This template is provided for reference purposes only, to assist those interested in developing forms and documents which fit the needs of their program. This is not a substitute for advice from a qualified legal, policy, regulatory or other subject matter expert. Legal requirements may vary based on differences in state and local laws, as well as special populations served or the type of operation.