Master Client Casework Form
Use this one form for disaster, homeless and HUD casework, VA support, food and peer support, client consent, uploads, and authorization to talk.
Veterans-Specific Intake Variation
Use this section when the client is a veteran and you need service-specific intake details.
Program Areas Needed
Program areas needed
Disaster Relief
HUD / Homeless
VA Support
Food Assistance
Peer to Peer
Housing
Benefits / Forms
Transportation
Spiritual Support
Case Details and Assessment
Current housing status
Select one
Unsheltered
Emergency shelter
Transitional housing
Hotel / motel
Temporarily staying with others
Rental housing at risk
Permanent housing
Case priority
Select one
Routine
Urgent
High Risk
Life Safety Concern
Client story / presenting problem *
Immediate unmet needs
Case plan / next steps *
Referrals made / agencies contacted
Authorization to Talk / Release of Information
Use this section when the client authorizes Heaven-Sent to speak with a landlord, FEMA worker, HUD or housing contact, VA staff, shelter, family member, or another service provider.
Purpose of authorization
Disaster casework and recovery assistance
Housing, shelter, HUD, or homelessness coordination
Veteran or VA-related support and navigation
Benefits verification, forms, and document support
Food, peer support, transportation, or basic needs coordination
Information allowed to be discussed
Information types allowed
Contact information
Case status
Housing status
Disaster impact
Income and benefits
Veteran status
Supporting documents
Appointments and referrals
I understand this form allows Heaven-Sent to speak with the person or organization named above for the purposes selected. *
I understand this authorization is voluntary and may be limited or refused unless a separate program form is required. *
I understand I may revoke this authorization in writing, except to the extent action has already been taken. *
Print / Save Authorization PDF
Download Authorization PDF
Save Full Casework Form
Clear Form
Print / Save Full PDF
Download Full Intake PDF
Open Second Intake Panel
Form validated and ready to submit.
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