Crisis Hotline Caller Intake & Risk Assessment Form
Crisis Hotline Caller Intake & Risk Assessment Form
Counselor-completed intake capturing caller risk factors, protective factors, and safety plan details during a crisis hotline call.
Call start time
Call end time
Counselor name or ID *
Your answer
Caller preferred name *
Your answer
Caller age range
Under 13
13-17
18-24
25-44
45-64
65+
Unknown
Caller identified pronouns
Your answer
Primary concern
Current thoughts of suicide?
+ 12 more questions
About this template
Counselor-completed intake capturing caller risk factors, protective factors, and safety plan details during a crisis hotline call.
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