Know which placement leads are worth a care assessment
Our intake captures the person's current level of daily assistance, how soon placement needs to happen, and which funding sources apply, along with any care assessment documents families can share upfront.
The exact intake your assisted living placement leads complete
This is the real 6-question guided intake for Assisted Living Placement — the same flow your customers finish before you ever pick up the phone.
What a qualified assisted living placement lead should tell you
Intake used when a family, individual, or care coordinator is trying to match a senior with an appropriate assisted living community based on current care needs, timeline, and how the placement will be paid for.
- Seeking Assisted Living Placement
- Level Daily Assistance Person
- Preferred General Location Assisted
- Soon Placement Happen
- Have Legal Authority Make
- Funding Sources Will Be
The questions your team needs answered
Every assisted living placement intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who are you seeking assisted living placement for? | Identifying whether the submitter is the individual, a family member, or a professional coordinator changes who your team should follow up with directly. |
| What level of daily assistance does the person currently need? | The level of daily assistance needed tells your team whether the community's staffing and memory-care programming can actually serve this person. |
| What is the preferred general location for the assisted living community? | Captures the detail in the patient’s own words so you’re briefed before the first call. |
| How soon does placement need to happen? | How soon placement needs to happen separates immediate, high-priority families from early-stage researchers so your team can sequence outreach correctly. |
| Do you have legal authority to make placement decisions for this person? | Confirming legal authority upfront avoids scheduling a care assessment with someone who can't actually approve the placement. |
| Which funding sources will be used to pay for care? | Knowing the funding sources, including Medicaid or veterans benefits, lets your team flag affordability questions before the first conversation. |
How Cliont scores assisted living placement leads
Every answer is weighted automatically — no manual review required.
Value signals
- Minimal help, mostly independent
- Moderate help with daily activities
- Extensive help with most daily activities
- Needs memory-related supervision
- Within a month
- 1-3 months
Urgency signals
- Immediately
See the lead your team receives
Assisted Living Placement 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 assisted living placement workflows
| Cliont capability | Assisted Living Placement application |
|---|---|
| Lead scoring | Combines the care-level answer with the placement timeline so an extensive-care, immediate-need lead ranks above a minimal-help, just-exploring inquiry. |
| Conditional intake flow | Recognizes when the submitter is a care coordinator rather than a family member and can route contact follow-up accordingly. |
| Document collection | Requests care assessment or medical summary documents and, where relevant, power of attorney paperwork before a care assessment is scheduled. |
| Multi-select capture | Records every funding source a family selects, including Medicaid or veterans benefits, so pricing conversations start with accurate expectations. |
| CRM routing | Sends leads with confirmed legal authority and a defined timeline directly into your placement coordinator's queue in the CRM. |
Common assisted living placement lead scenarios
Discharge-driven, extensive care needs
A family needs placement immediately after a hospital or rehab discharge and the person requires extensive help with most daily activities; the intake flags this combination as high priority.
Memory care supervision inquiry
An adult child is looking for a community for a parent who needs memory-related supervision rather than physical assistance, with a 1-3 month timeline while other arrangements wind down.
Care coordinator submitting on behalf of client
A professional care coordinator fills out the intake for a client, so the request needs to be routed with the coordinator's contact details rather than a family decision-maker's.
Early exploration, no urgency yet
A family member is still gathering information for someone who is mostly independent and hasn't set a placement date, with funding still marked as 'not sure.'
Legal authority not yet established
A relative is inquiring but hasn't been granted power of attorney or guardianship yet, which changes how far the conversation can go before that authority is confirmed.
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 assisted living intake templates
Assisted Living Placement lead-intake FAQs
What happens when the person filling out the intake isn't sure who has legal authority to make placement decisions?
The intake asks directly whether the person completing it has legal authority to decide, and a 'no' answer is weighted lower than a 'yes' so your team knows to confirm decision-making authority before scheduling a care assessment.
Can the intake tell the difference between a family that's just exploring and one that needs placement now?
Yes. The timeline question separates 'immediately' and 'within a month' from 'just exploring options,' and those answers carry very different weight so urgent placements surface ahead of early research inquiries.
How does the intake handle a person who needs memory-related supervision instead of physical assistance?
The care-level question includes memory-related supervision as its own option, distinct from moderate or extensive physical help, so your team can see at a glance whether the lead is a fit for memory care programming.
Does the intake capture how the family plans to pay for care?
Yes, families select all applicable funding sources including private pay, long-term care insurance, veterans benefits, Medicaid, or 'not sure,' which helps your team gauge affordability before the first call.
Can a professional care coordinator submit an inquiry instead of a family member?
Yes, the first question lets the person completing the intake identify themselves as the individual, a family member, or a care coordinator managing placement for a client or patient.
Does the intake ask for a specific community or just a general area?
It asks for the preferred general location as free text, so families can name a city, neighborhood, or region without being forced to pick from a fixed list of communities.
Turn assisted living placement visitors into qualified patients
Give every assisted living placement visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.