Social Care Follow-Up Call Form
Document social care follow-up calls, current needs, progress, and next steps.
Client and Call Details
Client Name
*
First Name
Last Name
Preferred Contact Phone Number / Callback Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Contact Method
Call Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Call Time
*
Hour Minutes
AM
PM
AM/PM Option
Staff Member / Caseworker Completing Form
*
Follow-Up Reason and Current Situation
Reason for Follow-Up Call
*
Scheduled check-in
Missed appointment follow-up
Service update
Concern escalation
Referral follow-up
Other
Current Situation / Concern Summary
Services Currently Involved / Received
Case management
Counseling
Housing support
Benefits assistance
Medical care
Mental health support
Substance use support
Family support
Other
Needs, Progress, and Action Plan
Progress since last contact
Current unmet needs or barriers
Housing
Food insecurity
Transportation
Financial hardship
Health/medical needs
Childcare
Access to services
Language barrier
Safety concern
Other
Urgency / risk level
*
Low
Moderate
High
Critical
Next step needed
*
Please Select
Referral
Escalation
Additional information required
No further action
Other
Follow-up action plan
Planned next contact date and time
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: