Know which memory day program leads are worth care assessment time
Ask about memory loss severity, daily living support needs, and decision-maker authorization up front, and collect diagnosis documentation before your team schedules a care assessment.
The exact intake your memory day program leads complete
This is the real 7-question guided intake for Memory Day Program — the same flow your customers finish before you ever pick up the phone.
What a qualified memory day program lead should tell you
A structured daytime program that provides supervised activities, cognitive engagement, and safety monitoring for adults experiencing memory loss or dementia-related decline, matched to the level of daily-living support and behavioral supervision each person needs.
- This Program
- Person Show Noticeable Memory
- Person Help With Daily
- Many Days Per Week
- Soon Program Start
- Legal Decision-Maker Or Primary
- Person Have Any Behaviors,
The questions your team needs answered
Every memory day program intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this program for? | Segments the lead so you can route, price, and prioritize it correctly. |
| Does the person show noticeable memory loss or confusion that affects daily activities? | A yes answer signals meaningful cognitive decline, which is exactly the population this program is built to serve. |
| Does the person need help with daily tasks like eating, walking, or using the restroom? | Needing help with eating, walking, or restroom use tells the team what supervision and staffing level to prepare for. |
| How many days per week are you looking to schedule? | Knowing whether they want 1-2 days or 5+ days helps the team gauge fit against available program capacity. |
| How soon do you need the program to start? | The urgency of the start date determines how quickly a care assessment needs to be scheduled and a slot held open. |
| Are you the legal decision-maker or primary caregiver authorized to enroll this person? | Confirming legal authority upfront avoids scheduling an assessment with someone who can't actually enroll the person. |
| Does the person have any behaviors, such as wandering or agitation, that staff should be aware of? | Flagging wandering or agitation lets staff prepare safety protocols before the person's first day instead of discovering it on-site. |
How Cliont scores memory day program leads
Every answer is weighted automatically — no manual review required.
Value signals
- Person Show Noticeable Memory: yes
- Person Help With Daily: yes
- Within a month
- Legal Decision-Maker Or Primary: yes
Urgency signals
- Immediately
- Planning ahead, no urgent date
See the lead your team receives
Memory Day Program 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 memory day program workflows
| Cliont capability | Memory Day Program application |
|---|---|
| Weighted lead scoring | Combines the memory loss, daily-task-assistance, and start-timing answers so a caregiver reporting immediate needs across all three scores meaningfully higher than a planning-ahead enquiry. |
| Behavior flagging | The wandering/agitation multi-select is surfaced as a distinct note on the lead record so staff can prepare supervision plans before the care assessment, not after. |
| Authorization check | When the decision-maker question comes back no, the lead is marked for confirmation of legal authority instead of being scheduled straight into an assessment slot. |
| Document collection | Requests diagnosis or cognitive evaluation records upfront so the team has supporting documentation on hand before the first conversation. |
| CRM routing | Delivers the full set of answers — memory status, daily-task needs, schedule preference, and authorization — as a single scored record in your CRM rather than a bare enquiry. |
Common memory day program lead scenarios
Sudden decline forces immediate need
Family reports noticeable memory loss and daily task help needed, with a start timing of Immediately and a confirmed primary caregiver — the intake flags this for a care assessment right away.
Care coordinator planning ahead
A client coordinator submits the enquiry on behalf of someone, selects Planning ahead with no urgent date, and marks days per week as Not sure — logged for follow-up rather than immediate scheduling.
Enrollment authority unclear
The person filling out the form answers no to being the legal decision-maker or primary caregiver, so the lead is flagged for the team to confirm who can actually authorize enrollment before booking an assessment.
Behavioral safety flags noted
Family selects wandering or agitation on the behaviors question, giving staff advance notice to prepare supervision plans before the first care assessment.
Early-stage memory changes, independent daily living
Memory loss is noted but the person doesn't need help with daily tasks and the family is just planning ahead — a lower-intensity combination the team may want to route toward a different day program.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book visits
Google Calendar, Outlook Calendar, Calendly
Notify your team
Email, SMS, Slack
Automate follow-up
Zapier, Webhooks, API
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 adult day services intake templates
Memory Day Program lead-intake FAQs
How does the intake tell an urgent memory day program enquiry apart from a family that's just researching?
The start timing question separates Immediately, Within a month, and Planning ahead, and when that's combined with the memory loss and daily task questions, the team can see at a glance which leads need scheduling now versus later.
What happens if the person submitting the form isn't the legal decision-maker?
That's captured directly by the authorization question, so a 'no' answer flags the lead for the team to confirm who actually has authority to enroll before an assessment is booked.
Can the intake surface behavioral concerns like wandering before the first visit?
Yes — the behaviors question lets families select wandering, agitation, or other concerns, and those answers travel with the lead into your CRM so staff aren't caught off guard.
How is this different from your Adult Day Care or Social Day Program intake?
The memory day program intake weighs cognitive decline, daily-living assistance, and behavioral flags more heavily, since those factors determine fit for a memory-specific setting rather than general day care or social programming.
What if the family isn't sure how many days per week they need?
The schedule question includes a Not sure option, so the lead still comes through complete and the team can address scheduling during a follow-up conversation instead of losing the enquiry.
Does the family need to already have a diagnosis on hand to submit the form?
No — supporting documentation is requested as part of the intake, but the memory loss and daily task questions are enough to qualify and route the lead while records are gathered.
Turn memory day program visitors into qualified patients
Give every memory day program visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.