Know which residential treatment leads deserve an intake slot
This intake captures whether outpatient care has already been tried, confirms the person is in a safe living situation, and gathers insurance details and referral documents — so your team only holds a slot for someone ready to move forward.
Preview your residential treatment assessment intake
Explore 6 questions from the Residential Treatment Assessment template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified residential treatment assessment lead should tell you
A structured evaluation that determines whether a person's substance use severity, safety, and history of prior treatment support a residential (live-in) level of care rather than an outpatient alternative.
- This Assessment
- This Person Already Tried
- Person In Safe Living
- Soon Residential Treatment Being
- ( Person Completing This)
- Insurance Or Payment Coverage,
The questions your team needs answered
Every residential treatment assessment intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this assessment for? | Knowing whether the respondent is the future client or a family member/proxy determines how much of the remaining answers can be treated as confirmed versus needing verification with the individual directly. |
| Has this person already tried outpatient or less intensive treatment? | Separates people stepping down from unsuccessful outpatient care from first-time inquiries, which changes how a treatment team routes and prioritizes the referral. |
| Is the person currently in a safe living situation while awaiting assessment? | An unsafe living situation is a signal for urgent triage rather than routine scheduling, regardless of how the rest of the assessment scores. |
| How soon is residential treatment being considered? | Turns a stated timeline into a scheduling priority, so requests for placement within days aren't queued the same way as someone still just exploring options. |
| Are you (the person completing this) authorized to make treatment decisions for the individual? | Confirms whether the person submitting the form actually has authority to commit to treatment decisions, which affects how likely a held slot is to convert. |
| What type of insurance or payment coverage, if any, is available for treatment? | Lets staff check payer type against bed availability and documentation requirements before confirming an assessment slot, even though it isn't used to rank fit. |
How Cliont scores residential treatment assessment leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Yes, without lasting success
- Yes, currently in outpatient care
- No, this would be the first step
- Not sure
- Person In Safe Living: yes
- Within a few weeks
Urgency signals
- Immediately, within days
Disqualifiers
- Not sure yet
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Residential Treatment Assessment Lead
From first click to qualified lead
Follow patients and caregivers through one smooth, guided flow.
They land & meet you
Your video greeting plays instantly — a real face instead of a blank form.
They explain the visit
Smart questions adapt to their visit and capture the full scope.
They share details
Symptoms, history, and documents come attached before the visit.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for residential treatment assessment workflows
| Cliont capability | Residential Treatment Assessment application |
|---|---|
| Conditional branching | Follow-up questions about payer details adjust based on whether the respondent selects private insurance, public coverage, self-pay, or 'not sure yet,' instead of showing the same fields to everyone. |
| Weighted lead scoring | A response indicating an unsafe living situation combined with a lack of decision-making authority is surfaced for manual review before your team commits to holding an assessment slot. |
| Document and photo upload widget | Families referencing a prior outpatient episode can attach a referral or discharge summary directly, giving your intake staff context before the assessment call. |
| CRM routing | Completed assessments are sent to your CRM tagged with the stated placement timeline, so 'within days' requests are visibly separated from 'just exploring' inquiries. |
Example residential treatment assessment lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Family calling in crisis
A family member submits the form for someone who has never tried treatment before and wants placement within days — the intake flags both the first-treatment-attempt answer and the immediate timeline as high value.
Step-down after failed outpatient
The person has already tried outpatient care without lasting success and now needs a higher level of care within a few weeks — this history carries more weight than a first-time inquiry.
Safety concern surfaces mid-intake
The respondent answers that the person is not currently in a safe living situation while awaiting assessment, which the intake treats as a signal for urgent review rather than routine scheduling.
Early-stage exploration
Someone is just exploring options, hasn't settled a timeline, and isn't sure about insurance — the intake still captures the details but this profile scores lower than a decision-ready inquiry.
Submitted without decision authority
A friend or acquaintance fills out the assessment but isn't authorized to make treatment decisions for the individual, which the intake distinguishes from submissions made by a parent, spouse, or legal decision-maker.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
Lawmatics, MyCase, Clio Manage and Clio Grow
Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
Simple, transparent pricing
Choose the plan that works for your business.
Professional
Unlimited intake forms and leads for your growing business.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Advanced analytics dashboard
Pay Per Lead
Only pay when you receive a qualified lead.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Charged only for submitted leads
More substance use treatment intake templates
Residential Treatment Assessment lead-intake FAQs
How does the intake tell a step-down referral apart from a first-time inquiry?
The form asks whether the person has already tried outpatient or less intensive treatment, with separate options for 'without lasting success,' 'currently in outpatient care,' and 'first step,' so your team can see at a glance which pathway the lead represents.
What happens if the person filling out the form isn't the one who would receive treatment?
The intake asks who the assessment is for and whether the respondent is authorized to make treatment decisions, so a submission from an unauthorized third party is flagged differently than one from a parent or spouse.
Does the intake catch safety concerns before a slot gets held?
Yes — it asks directly whether the person is currently in a safe living situation while awaiting assessment, and an unsafe answer is treated as a signal for closer review rather than automatic scheduling.
How is urgency factored into the score?
The stated timeline — immediate, within weeks, within months, or just exploring — carries different weight, so an 'immediately, within days' response is prioritized ahead of a general inquiry.
Why does the insurance question not affect the score?
Payment type is collected for logistics — matching payer requirements to bed availability — rather than as a fit signal, so private insurance, public coverage, self-pay, and 'not sure yet' are all recorded without weighting the lead up or down.
Can this same intake handle referrals to a different level of care?
This form is specific to residential assessment; related intakes exist for Outpatient Assessment and Intensive Outpatient Program if the answers suggest a lower level of care is more appropriate.
Turn residential treatment assessment visitors into qualified patients
Give every residential treatment assessment visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.