Turn daily living support enquiries into care assessment-ready leads
Families tell you exactly which daily activities need support, how urgent the need is, and whether there's been a recent fall — plus upload medication lists and home photos so your team can review before the first call.
The exact intake your daily living support leads complete
This is the real 7-question guided intake for Daily Living Support — the same flow your customers finish before you ever pick up the phone.
What a qualified daily living support lead should tell you
Ongoing help with routine activities of daily living—bathing, dressing, mobility, meals, medication reminders, and toileting—for someone who can no longer safely manage these tasks alone.
- This Care Request
- Daily Activities Assistance
- Person Live
- Soon Daily Living Support
- Authorized Make Care Decisions
- There Already Caregiver Or
- Person Had Fall Or
The questions your team needs answered
Every daily living support intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this care request for? | Knowing whether the requester is the person themselves, a family member, or a professional coordinator shapes how your team opens the first conversation. |
| Which daily activities currently require assistance? | Each selected activity carries its own weight, so a lead needing bathing, mobility, and toileting help scores higher than one needing only light housekeeping. |
| Where does the person currently live? | Segments the lead so you can route, price, and prioritize it correctly. |
| How soon is daily living support needed? | The stated timeline separates families ready for a care assessment this week from those still comparing options months out. |
| Are you authorized to make care decisions for this person? | A yes carries far more weight than a no, since a lead from someone without decision authority still needs the actual decision-maker identified before you can proceed. |
| Is there already a caregiver or facility staff providing some support? | Knowing whether family, a paid caregiver, or facility staff already provide some support tells you how much of a care gap actually exists. |
| Has the person had a fall or safety incident in the past year? | A recent fall or safety incident raises the urgency of the lead independent of the timeline the family selected. |
How Cliont scores daily living support leads
Every answer is weighted automatically — no manual review required.
Value signals
- Bathing or dressing
- Mobility or transfers
- Meal preparation or eating
- Medication reminders
- Toileting
- Light housekeeping
Urgency signals
- Immediately
See the lead your team receives
Daily Living Support Lead – Immediate Need
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 daily living support workflows
| Cliont capability | Daily Living Support application |
|---|---|
| Weighted answer scoring | The multi-select activities question weighs bathing, mobility, and toileting needs higher than light housekeeping, so families with intensive daily needs surface above lighter requests automatically. |
| Conditional flagging | A 'no' on the authorization question drops the lead's confidence score, prompting your team to verify the real decision-maker before scheduling a care assessment. |
| Safety-risk tagging | A reported fall or safety incident raises the lead's urgency tag independently of the stated timeline, so past-year fall history doesn't get buried under a 'within a month' response. |
| CRM record sync | Each submitted intake pushes structured fields — activities needed, residence type, existing support, and timeline — directly into the CRM record instead of arriving as a plain message. |
Common daily living support lead scenarios
Post-fall urgent request
A family reports a recent fall and needs help with bathing, mobility, and toileting immediately — the intake flags the fall history and urgency together so this reaches your team ahead of exploratory enquiries.
Coordinator managing care remotely
A relative or professional care coordinator submits the request on behalf of someone still living in their own home with no current support in place, so you know upfront who holds decision-making authority before scheduling an assessment.
Facility resident needs added support
The person already lives in an assisted living facility with staff providing some care, but the family wants extra help with meals or medication reminders — a different service scope than a first-time placement.
Early-stage exploration
A family selects 'no specific needs yet' and 'just exploring options,' signaling a lower-urgency lead better suited to nurture follow-up than an immediate care assessment.
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
Daily Living Support lead-intake FAQs
How does the intake tell urgent daily living needs apart from families still researching options?
The timeline question separates 'Immediately' from 'Within a month' or 'Just exploring options,' and combined with the activities selected, this lets you prioritize same-week outreach over long-term nurture leads.
What happens if the person submitting the form isn't authorized to make care decisions?
The authorization question carries a lower weight when the answer is no, so your team can flag those leads to confirm who the actual decision-maker is before booking a care assessment.
Does the intake capture fall history for safety screening?
Yes — families report whether there's been a fall or safety incident in the past year, which raises the urgency of the lead so higher-risk situations aren't treated the same as routine requests.
How is this different from the Assisted Living Placement or Senior Living Tour intakes?
Daily Living Support focuses on which specific activities — bathing, mobility, meals, medication, toileting — someone needs help with right now, rather than screening for a facility search or scheduling a tour.
What documents does Cliont ask families to upload?
The intake collects home photos for fall-risk context, a current medication list, and a recent hospital discharge summary or care plan when one exists, so your team walks into the assessment already informed.
Can this intake handle a lead for someone who already lives in a facility?
Yes — the residence question includes 'assisted living facility' as an option, and the existing-support question distinguishes between facility staff, a paid caregiver, or family already helping, so you understand the current care gap.
Turn daily living support visitors into qualified patients
Give every daily living support visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.