Domestic Violence Intake Assessment Form and Questionnaire

Build a safer, more consistent domestic violence intake process with CharityTracker. Create customizable assessment forms that capture essential client needs, incidents, service requests, and goals while helping authorized teams protect sensitive records. Remote and kiosk intake options reduce barriers for survivors, and centralized case management supports secure follow-up, referrals, outcome tracking, and reporting for programs serving communities across the United States.

Caseworker reviewing a secure digital intake assessment

Our Domestic Violence Intake Services

Digital tools for confidential assessments, intake, case coordination, documentation, and survivor-centered follow-up.

Custom Assessments

Create tailored domestic violence intake assessment forms that capture demographic, situational, incident, service-request, and goal information needed to guide individualized support.

Digital Client Intake

Replace paper forms with staff-led digital intake that records client information, case notes, documents, and assistance requests in one organized client profile.

Remote Kiosk Intake

Let clients complete intake and request assistance digitally from anywhere or through a kiosk, reducing administrative barriers and saving staff time.

Secure Case Files

Store intake forms, identification records, case notes, and supporting documents securely in a centralized digital filing cabinet accessible to authorized staff.

Journey Tracking

Track incidents, program enrollment, service requests, milestones, and ongoing case notes from first intake through program completion or stability.

Network Referrals

Coordinate referrals and resource availability with trusted partner agencies while maintaining appropriate release-of-information documentation and data-entry practices.

Confidential Digital Intake

Intake Tools Built Around Survivor Support

CharityTracker helps domestic violence programs turn complex intake questionnaires into a consistent, survivor-centered digital workflow. Customize assessments around your organization’s services, capture information once, and keep authorized records, documents, requests, and case notes together. Staff can complete intake directly, while remote and kiosk options offer another way to request help. From immediate needs to ongoing goals, your team gains clearer information for coordinated care and meaningful reporting.

Nonprofit staff member completing a digital intake form
The CharityTracker Difference

Why Choose CharityTracker?

Purpose-built tools help mission-driven teams spend less time on paperwork and more time supporting people.

Crisis-Born Experience

Founded during Hurricane Katrina relief efforts, CharityTracker understands the urgency of coordinated crisis response.

Secure Records

HIPAA-aligned safeguards support confidential client data management and applicable federal, state, and local requirements.

Remote Access

Available 24/7/365, the platform enables authorized teams to manage intake and cases from anywhere.

Proven Reach

Serving over 2,500 U.S. communities, CharityTracker supports collaboration across nonprofit, government, and faith-based teams.

Meet the CharityTracker Team

Mission-driven specialists supporting stronger community services nationwide.

Portrait of Michael Simon, President of CharityTracker

Michael Simon

President

Michael Simon serves as President of CharityTracker, a role he fulfills with a deep commitment to the organization's founding mission of empowering charitable organizations through innovative software. Since the company's inception in 2006 during Hurricane Katrina relief efforts, Michael has helped shape CharityTracker into a trusted platform now serving over 2,500 communities across the United States. His leadership style blends strategic vision with hands-on dedication, ensuring that every product decision reflects the real-world needs of nonprofits, government agencies, and community organizations. Michael is passionate about helping mission-driven teams operate more efficiently so they can focus on creating lasting, transformative change in the communities they serve.

Portrait of Isaac Simon, CEO of CharityTracker

Isaac Simon

CEO

Isaac Simon serves as Chief Executive Officer of CharityTracker, providing strategic direction and executive leadership for the company's mission to strengthen communities through purpose-built software solutions. Known for his personable and approachable style, Isaac fosters a culture of collaboration, responsiveness, and genuine connection with clients. He plays a central role in guiding CharityTracker's growth as the platform continues to expand its reach to nonprofits, faith-based ministries, government agencies, and social service organizations across the USA. Under his leadership, the company remains steadfastly committed to its core values of listening first, doing the right thing, and continually evolving to better serve those who help others.

Portrait of Greg Hammond, Customer Success Specialist at CharityTracker

Greg Hammond

Customer Success

Greg Hammond is a Customer Success specialist at CharityTracker, dedicated to helping nonprofit and community organizations get the most out of the platform. As part of CharityTracker's client-focused support team, Greg works closely with users to ensure seamless onboarding experiences and continued satisfaction throughout their journey with the software. His role reflects the company's core value of listening first — being present and responsive at every stage of the client relationship. Greg is committed to making sure each organization he supports has the tools, knowledge, and confidence to effectively manage their programs, track client outcomes, and maximize their community impact.

Portrait of Ann Watt, Sales and Implementation Specialist at CharityTracker

Ann Watt

Sales & Implementation

Ann Watt is a Sales & Implementation specialist at CharityTracker, bringing expertise in client onboarding and software deployment to help organizations quickly adopt the platform and begin maximizing their impact. Ann works closely with new clients to ensure a smooth transition from evaluation to full implementation, guiding teams through setup, training, and early use of the system. Her approach reflects CharityTracker's promise of quick, approachable implementation — enabling nonprofits, government agencies, and community organizations to start tracking, measuring, and reporting within minutes. Ann is passionate about empowering mission-driven organizations with the tools they need to serve their communities more effectively.

Portrait of Kyle Minckler, Sales and Implementation Specialist at CharityTracker

Kyle Minckler

Sales & Implementation

Kyle Minckler is a Sales & Implementation specialist at CharityTracker, supporting client acquisition and onboarding with professionalism and a genuine commitment to the company's mission. Kyle works with prospective and new clients to demonstrate the platform's capabilities and guide them through the implementation process, ensuring organizations can quickly put CharityTracker to work for their communities. He brings a friendly, consultative approach that aligns with the company's values of transparency, dignity, and client-centered service. Kyle is dedicated to making the transition to digital case management as smooth and impactful as possible for every organization he works with across the nonprofit, government, and faith-based sectors.

Portrait of Joey Yarber, Sales and Implementation Specialist at CharityTracker

Joey Yarber

Sales & Implementation

Joey Yarber is a Sales & Implementation specialist at CharityTracker, responsible for conducting client demonstrations, supporting software onboarding, and guiding nonprofit and community organizations through the deployment process. Joey plays a key role in helping new clients understand the full range of CharityTracker's capabilities — from case management and digital intake to inter-agency collaboration and funder reporting. His work ensures that organizations are fully equipped to harness the platform from day one, reducing paperwork and improving service delivery. Joey is committed to making every client feel supported and confident as they begin their CharityTracker journey, embodying the company's people-first approach to customer relationships.

Portrait of Jason Gabriel, Sales and Implementation Specialist at CharityTracker

Jason Gabriel

Sales & Implementation

Jason Gabriel is a Sales & Implementation specialist at CharityTracker, focused on helping nonprofit and community organizations adopt the platform quickly and effectively. Jason supports clients through every step of the onboarding process, from initial demonstrations to full software deployment, ensuring teams are set up for long-term success. His work is grounded in CharityTracker's mission to make powerful case management tools accessible and approachable for organizations of all sizes. Jason takes pride in helping clients eliminate paperwork, improve coordination, and begin generating meaningful community impact data from day one, reflecting the company's commitment to doing things right and doing the right thing.

Portrait of Jon Lucius, Software Developer at CharityTracker

Jon Lucius

Developer

Jon Lucius is a software developer at CharityTracker, contributing technical expertise to the ongoing development and enhancement of the platform. As part of the dedicated development team at Simon Solutions, Jon works to build reliable, innovative features that help nonprofits, government agencies, and community organizations manage their work more efficiently. His technical contributions support critical capabilities such as digital intake, barcode scanning, case management workflows, and data security compliance. Jon is motivated by the meaningful nature of CharityTracker's mission, knowing that the software he builds directly supports organizations working to create lasting, positive change in communities across the United States.

Portrait of Riley Smith, Software Developer at CharityTracker

Riley Smith

Developer

Riley Smith is a software developer at CharityTracker, dedicated to building and continuously improving the platform's capabilities to better serve the nonprofit and community organizations that rely on it. As part of the Simon Solutions development team, Riley contributes to a product that has grown from its Hurricane Katrina origins into a comprehensive case management solution serving over 2,500 communities nationwide. Riley's work encompasses platform enhancements, new feature development, and ensuring the system remains reliable and secure for clients around the clock. He is driven by the opportunity to apply technical skill in service of a mission that genuinely helps those who help others.

Portrait of Darwin Anderson, Software Developer at CharityTracker

Darwin Anderson

Developer

Darwin Anderson is a software developer at CharityTracker, bringing technical skill and a strong commitment to community impact to the organization's development team. Darwin contributes to the ongoing evolution of the CharityTracker platform, helping to deliver innovative features that streamline case management, improve data security, and enhance the experience for nonprofit and social service users nationwide. His work is guided by the company's core philosophy of continuous improvement and its dedication to building tools that create real, measurable change in communities. Darwin takes pride in being part of a team whose software directly empowers organizations helping individuals and families break cycles of poverty and crisis.

Portrait of Rachel Fisher, Customer Success Specialist at CharityTracker

Rachel Fisher

Customer Success

Rachel Fisher is a Customer Success specialist at CharityTracker, focused on supporting clients and ensuring they achieve their goals using the platform. Rachel works alongside nonprofit organizations, government agencies, and community groups to provide ongoing guidance, troubleshoot challenges, and help users unlock the full potential of CharityTracker's case management tools. Her role reflects the company's unwavering commitment to being present with clients every step of the way — from implementation and beyond. Rachel embodies CharityTracker's core value that everyone matters, ensuring every user feels heard, supported, and equipped to make a meaningful difference in the communities they serve.

Portrait of Atticus Wright, Software Developer at CharityTracker

Atticus Wright

Developer

Atticus Wright is a software developer at CharityTracker, contributing to the platform's technical development and the organization's broader mission to support those who help others. As a member of the Simon Solutions development team, Atticus works to build and refine features that enable nonprofits, healthcare organizations, faith-based ministries, and government agencies to manage client data more effectively and serve their communities with greater efficiency. His technical contributions help ensure that CharityTracker remains a cutting-edge, secure, and reliable tool for over 2,500 communities across the United States. Atticus is committed to the idea that great technology, built with purpose, can drive transformative community change.

Frequently Asked Questions

What is the form used to assess domestic abuse?

Organizations commonly use a domestic violence intake assessment or domestic abuse screening questionnaire. It may document immediate safety concerns, incident history, household details, housing needs, requested services, referrals, and follow-up goals. The exact questions should align with the organization’s policies, survivor-centered practices, confidentiality obligations, and applicable local, state, and federal requirements. CharityTracker lets programs customize these assessments for their own workflows.

Can we customize a domestic violence intake questionnaire?

How does remote intake work for survivors?

Can staff store intake forms and case documents digitally?

How can multiple agencies coordinate referrals safely?

Does CharityTracker support domestic violence reporting requirements?

What does CharityTracker cost for intake assessments?

How quickly can our program begin using the platform?

Questions About Your Intake Workflow?

Talk with our team about secure, customizable assessment and case-management tools.

Trusted Platform

Awards and Recognition

CharityTracker established since 2006 trust badge

Established Since 2006

Crisis-response roots and long-term platform experience.

HIPAA-aligned security badge

HIPAA-Aligned Security

Supports confidential client-data management practices.

Nationwide community reach badge

Nationwide Community Reach

Supporting over 2,500 U.S. communities.

Build a Better Domestic Violence Intake Process

Request a free demo to explore customizable assessments, remote intake, secure case records, and coordinated referral tools.

Contact Us Today

For immediate assistance, feel free to give us a direct call at 888-764-0633.