Know which respite stay leads are worth a care assessment
Ask upfront when the stay needs to start, how long it will last, and whether daily help with bathing or mobility is needed, then collect a current medication list so your team can confirm fit before scheduling a care assessment.
Preview your short-term respite stay intake
Explore 6 questions from the Short-Term Respite Stay template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified short-term respite stay lead should tell you
A temporary, time-limited assisted living stay that covers a senior's daily support and supervision needs while their regular caregiver is unavailable, ranging from a few days to several weeks.
- Respite Stay Begin
- Many Days Or Weeks
- Senior Help With Daily
- Senior Have Any Medical
- Requesting This Respite Stay
- Senior Stayed In Assisted
The questions your team needs answered
Every short-term respite stay intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| When do you need the respite stay to begin? | Timing carries the heaviest weight in the catalog, so an immediate or within-two-week start date is the clearest signal a lead needs a same-week response. |
| How many days or weeks do you expect the stay to last? | Segments the lead so you can route, price, and prioritize it correctly. |
| Does the senior currently need help with daily activities like bathing, dressing, or mobility? | A yes on daily activity assistance is one of the two flagged high-value signals and tells staff the level of supervision the stay will actually require. |
| Does the senior have any medical needs that require regular monitoring, such as medication management? | Medical monitoring needs like medication management indicate whether clinical staff availability needs to be confirmed before accepting the stay. |
| Who is requesting this respite stay? | Knowing whether a family caregiver, care coordinator, or the senior themselves is asking shapes how much guidance the follow-up call needs to provide. |
| Has the senior stayed in an assisted living facility before? | Prior stay history tells staff whether the family already understands your facility's routines or needs a fuller orientation during intake. |
How Cliont scores short-term respite stay leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Within 2 weeks
- Within 1 month
- Senior Help With Daily: yes
Urgency signals
- Immediately
Disqualifiers
- Not sure yet
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Short-Term Respite Stay 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 short-term respite stay workflows
| Cliont capability | Short-Term Respite Stay application |
|---|---|
| Weighted lead scoring | Requests needing to start immediately or within two weeks, combined with a yes on daily activity assistance, automatically score higher than exploratory inquiries. |
| Branching intake logic | The requester-type answer (family caregiver vs. professional care coordinator vs. senior themselves) can direct follow-up questions and staff routing differently. |
| CRM delivery | Completed respite stay intakes, including medication management and daily assistance answers, land directly in your CRM instead of a shared inbox. |
| Structured document collection | The intake pairs the medical-needs question with an upload request for a current medication list, so clinical context arrives with the lead rather than during the care assessment. |
Example short-term respite stay lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Sudden caregiver emergency
A family caregiver needs a bed immediately and the senior requires help with daily activities like bathing or dressing, so the intake surfaces this as a high-value, time-sensitive lead.
Planned vacation coverage
A family books a short stay of a few days weeks in advance for a senior who is largely independent, letting your team plan capacity around a lower-urgency, predictable request.
Hospital discharge transition
A professional care coordinator requests a stay with active medication management needs, flagging a lead that likely requires closer clinical review before acceptance.
Early-stage research inquiry
Someone marks the timing as just exploring options and isn't sure how long the stay would last, which the intake routes as informational rather than ready for immediate scheduling.
Returning respite family
A senior who has stayed before is coming back for another short stay, giving your team a known quantity that can move through intake faster than a first-time inquiry.
Connect Cliont to your workflow
Connect your CRM
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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 assisted living intake templates
Short-Term Respite Stay lead-intake FAQs
How does the intake prioritize respite stay requests that need to start right away?
The start-date question weighs immediate and within-two-week timing higher than exploratory inquiries, so requests needing to begin right away are flagged as higher priority in your CRM.
Does the form ask about medical needs before a family reaches our staff?
Yes, the intake asks whether the senior has medical needs requiring regular monitoring, such as medication management, so your team can see clinical complexity before the care assessment call.
Can I tell if the person filling out the form is family or a care coordinator?
The intake captures who is requesting the stay, family caregiver, professional care coordinator, the senior themselves, or other, so your team can tailor the follow-up conversation accordingly.
What happens if a family doesn't know how long the stay will last?
The duration question includes a not sure yet option, so those leads still come through and can be clarified during the care assessment rather than being dropped from intake.
Does the intake distinguish new families from those who've used respite care with us before?
It asks whether the senior has stayed in an assisted living facility before, giving your team context on familiarity with your process before the first conversation.
Where do qualified respite stay leads go once someone submits the form?
Every submission is scored against the catalog answers and sent to your CRM, so staff can see care needs and timing without re-asking the family.
Turn short-term respite stay visitors into qualified patients
Give every short-term respite stay visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.