Medication intake that flags when a nurse is required
Every family submission captures how many medications are involved, whether a licensed nurse is required, and how soon support needs to start — plus a photo of the current medication list — so your team knows what it's walking into before booking a care assessment.
The exact intake your medication support leads complete
This is the real 6-question guided intake for Medication Support — the same flow your customers finish before you ever pick up the phone.
What a qualified medication support lead should tell you
In-home support ranging from simple reminders and pill organization to hands-on administration and refill coordination, for older adults managing one or more prescribed medications.
- Help With Medications Needed
- Many Different Medications Person
- Licensed Nurse Required Administer
- Soon Medication Support Needed
- Person Who Can Authorize
- Person Receive Care
The questions your team needs answered
Every medication support intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What type of help with medications is needed? | Distinguishes low-touch reminder needs from hands-on administration, which requires different staffing and skill level to schedule correctly. |
| How many different medications does the person currently take? | A higher medication count signals more complexity in scheduling, tracking, and potential drug-interaction considerations. |
| Is a licensed nurse required to administer any of the medications? | A confirmed nurse requirement changes which staff can be assigned and typically signals a higher-acuity, higher-value case. |
| How soon is medication support needed to begin? | Immediate timing separates families ready to move forward now from those still exploring, letting your team prioritize outreach. |
| Are you the person who can authorize care services for this individual? | If the submitter cannot authorize care, the actual decision-maker needs to be identified before a care assessment is scheduled. |
| Where does the person currently receive care? | The current care setting helps determine whether in-home medication support is the right fit versus facility-based care already in place. |
How Cliont scores medication support leads
Every answer is weighted automatically — no manual review required.
Value signals
- Reminders to take medication on time
- Organizing pills into a schedule or dispenser
- Hands-on administration of medication
- Tracking refills and communicating with pharmacy
- Licensed Nurse Required Administer: yes
- Person Who Can Authorize: yes
Urgency signals
- Immediately
Disqualifiers
- Not sure yet
See the lead your team receives
Medication Support Lead — Immediate Need, Nurse Required
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 medication support workflows
| Cliont capability | Medication Support application |
|---|---|
| Weighted scoring engine | Automatically weights hands-on administration and confirmed nurse requirements higher than simple reminders, so acuity-heavy leads surface first. |
| Conditional flagging | Flags leads where the submitter is not the authorized decision-maker so staff can confirm the real point of contact before booking a care assessment. |
| Document collection | Captures the current medication list or pharmacy printout at intake so your team can assess medication count and complexity ahead of the visit. |
| CRM routing | Sends scored medication support leads, tagged with urgency and nurse-requirement status, directly into your CRM for follow-up. |
Common medication support lead scenarios
Immediate nurse-level need
The family selects hands-on administration, confirms a licensed nurse is required, and needs care to start immediately — this combination should route straight to the top of your queue.
Family still comparing options
The intake shows 'not sure yet' for the type of help and 'just exploring options' for timing, signaling a lead worth nurturing rather than rushing into an assessment.
Complex multi-medication regimen
Six or more medications combined with a need for schedule organizing or refill tracking points to a higher-acuity case your team can size up before the first call.
Caller isn't the decision-maker
When the person filling out the form indicates they cannot authorize care services, the intake flags this so staff can loop in the actual decision-maker before scheduling.
Reminder-only support in assisted living
A lead needing only timing reminders for someone already in an assisted living facility signals a lighter-touch engagement than hands-on administration at home.
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 home health care intake templates
Medication Support lead-intake FAQs
Does the intake tell me upfront if a licensed nurse is required?
Yes — the form asks directly whether any of the person's medications require licensed administration, and that answer carries some of the heaviest weight in the score so nurse-level cases stand out immediately.
How does the intake handle a caller who can't authorize care?
The form asks whether the submitter is the person who can authorize care services; if the answer is no, that lead scores lower on decision-making authority so your team knows to confirm who the real decision-maker is before booking.
Can families submit their current medication list before the assessment?
Yes, the intake collects a medication list or prescription photo alongside the answers, so your team can review the medication count and complexity before the first visit.
Does timing urgency change how a lead is prioritized?
Yes — families who select 'immediately' for when support needs to begin are flagged as urgent, separating them from families who are just exploring options.
Does the intake distinguish reminders from hands-on medication administration?
Yes, the type-of-help question separates simple reminders, pill organizing, refill tracking, and hands-on administration, each carrying a different weight so your team can gauge the acuity level before scheduling.
What if the person is in an assisted living facility rather than at home?
The intake asks where the person currently receives care, which helps your team judge whether medication support fits your service model or whether the lead is better suited to a facility-based option.
Turn medication support visitors into qualified patients
Give every medication support visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.