Addiction Intervention Services Inquiry Form

Professional Addiction Intervention Inquiry Form Template

When a loved one is struggling with addiction, reaching out for help is one of the most difficult—and most important—steps a family can take. This Addiction Intervention Services Inquiry Form is designed to help intervention specialists, addiction counselors, and treatment facilities gather the essential information needed to plan a safe, effective intervention while treating every inquiry with the compassion and urgency it deserves.

Why This Form Matters for Intervention Services

Addiction intervention is a delicate process that requires careful planning, professional expertise, and a deep understanding of each unique situation. This form template helps intervention professionals:

• Assess urgency and safety concerns before the first conversation
• Understand the substance use history and current patterns
• Evaluate family dynamics and support systems available for the intervention
• Determine insurance coverage and financial considerations upfront
• Gauge treatment readiness and identify potential barriers to recovery
• Plan the most appropriate intervention approach based on individual circumstances

By collecting this information through a thoughtfully designed online form, intervention services can respond more quickly and accurately to families in crisis, while giving concerned loved ones a private, non-judgmental way to reach out for help.

Key Features of This Template

This addiction intervention inquiry form includes:

Comprehensive Substance Use Assessment – Questions about the type of substance(s) being used, frequency, duration, and any previous treatment attempts help intervention specialists understand the scope of the addiction and tailor their approach accordingly.

Living Situation and Environment – Understanding where the individual currently lives, who they live with, and their daily environment is critical for planning a safe and effective intervention.

Insurance and Financial Information – Early clarity on insurance coverage and payment options helps families understand their options and removes barriers to moving forward with treatment.

Family Involvement and Support Network – Successful interventions depend on having the right people in the room. This form helps identify family members, friends, and other support persons who should be part of the process.

Treatment Readiness and Motivation – Gauging where the individual stands in terms of acknowledging their addiction and being open to help informs the intervention strategy.

Safety and Crisis Assessment – Questions about immediate danger, mental health concerns, and any history of violence ensure that intervention professionals can take appropriate precautions and prioritize safety.

Preferred Contact Methods and Timing – Families dealing with addiction often need discretion. This form allows them to specify how and when they prefer to be contacted.

Who Should Use This Form

This template is ideal for:

• Professional Interventionists who provide family intervention services and need to pre-screen potential clients
• Addiction Treatment Centers that offer intervention planning as part of their admissions process
• Behavioral Health Clinics that provide counseling and intervention support services
• Recovery Coaches and Sober Companions who work with families before, during, and after treatment
• Mental Health Practices that specialize in dual diagnosis and substance use disorders
• Employee Assistance Programs (EAPs) helping family members of employees struggling with addiction

Designed for Compassion and Confidentiality

Addiction carries stigma, and families reaching out for intervention services are often scared, overwhelmed, and unsure where to turn. This form is designed with a warm, supportive tone that acknowledges the courage it takes to ask for help. The questions are direct but never judgmental, and the form clearly communicates that all information will be kept strictly confidential.

The form flows logically from basic contact information through to the more sensitive questions about substance use and safety, allowing families to provide as much or as little detail as they're comfortable sharing at this initial stage.

Streamline Your Intake with Paperform

Built on Paperform's flexible platform, this template can be easily customized to match your organization's brand, intake protocols, and service offerings. Add your logo, adjust the color scheme, modify questions, or include additional fields for your specific intervention model.

Conditional logic ensures families only see relevant questions based on their answers—for example, showing insurance-specific questions only when insurance coverage is indicated, or displaying crisis resources if immediate safety concerns are identified.

Secure data collection gives families peace of mind that their sensitive information is protected. Paperform is SOC 2 Type II compliant, ensuring that all submissions meet high security standards.

Instant notifications alert your team the moment a new inquiry comes in, so you can respond quickly to families in crisis. Set up automated email responses that provide immediate reassurance and next steps while your team reviews the details.

Integration with your workflow means inquiry data can flow directly into your CRM, case management system, or client database through Paperform's native integrations or via Stepper workflows. Automatically create new client records, assign cases to intervention specialists, send follow-up sequences, and keep your team coordinated without manual data entry.

From Inquiry to Intervention: Building the Path to Recovery

This form is just the beginning of the intervention journey, but it's a critical first step. By making it easy for families to reach out and providing a clear, compassionate way to share essential information, you remove barriers to care and demonstrate your commitment to meeting families where they are.

Whether you're an established intervention practice or just adding intervention services to your treatment offerings, this template provides a professional, empathetic foundation for your client intake process. Customize it to reflect your unique approach, and start connecting with more families who need your help.

Families dealing with addiction shouldn't have to navigate complex intake processes or wait days for a response. With this Paperform template, you can offer immediate support and begin planning life-saving interventions faster. Start using this template today and be there when families need you most.