Support and Care When You Need It Most

Crisis pregnancy centers provide essential support to individuals facing unplanned pregnancies, and the first step in that journey is a welcoming, confidential intake process. This Crisis Pregnancy Center Visitor Intake Form is designed to help your center gather important information while creating a safe, non-judgmental environment for every visitor.

Why This Template Works for Crisis Pregnancy Centers

This intake form balances the need for thorough information collection with the sensitivity required in crisis pregnancy care. It captures visitor details, schedules ultrasound appointments, assesses immediate resource needs, and secures proper consent for counseling—all while maintaining the dignity and privacy of each individual.

The form includes sections for confidential personal information, pregnancy history, counseling consent, ultrasound appointment scheduling, resource assessment (housing, food, childcare, medical care), and acknowledgment of non-judgmental care principles. This comprehensive approach ensures your staff has the information needed to provide personalized, compassionate support from the very first visit.

Streamline Your Intake Process with Paperform

Built with Paperform's intuitive doc-style editor, this template can be customized to reflect your center's specific services, values, and branding. Use conditional logic to show relevant questions based on visitor needs, protecting privacy and reducing form fatigue. The form can be embedded on your website, shared via email, or displayed on a tablet in your waiting room for walk-in visitors.

Connect your workflow seamlessly: Integrate with your CRM or client management system to automatically create visitor records, send appointment confirmations, and trigger follow-up care sequences. Use Stepper to route urgent cases to counselors, schedule resources, and ensure no visitor falls through the cracks.

Ensure confidentiality and compliance: Paperform is SOC 2 Type II compliant and offers robust security features to protect sensitive visitor information. Set up secure data handling, limit staff access with role-based permissions, and maintain the trust that is essential in crisis pregnancy care.

Enhance Care with Integrated Tools

For centers that need appointment management, Paperform's built-in scheduling fields sync with your calendar to offer available ultrasound slots. If you need visitors to sign consent forms or acknowledgments, Papersign lets you send documents for secure eSignature, keeping everything linked to the original intake submission.

This template helps crisis pregnancy centers deliver the compassionate, confidential care that every visitor deserves—starting with a welcoming, well-organized intake experience.