Skilled nursing intake that asks what your team needs to know
Ask about the type of nursing care needed, whether a physician has ordered it, and how soon care should start — then collect the physician's orders and send every qualified assessment lead straight to your CRM.
The exact intake your skilled nursing leads complete
This is the real 6-question guided intake for Skilled Nursing — the same flow your customers finish before you ever pick up the phone.
What a qualified skilled nursing lead should tell you
Licensed nursing care delivered in the home for needs like wound care, medication management, IV therapy, vital-sign monitoring, and post-surgical recovery, typically initiated by a physician's order.
- Nursing Care Needed
- Doctor Ordered Or Recommended
- Will Care Take Place
- Soon Nursing Care Needed
- Person Needing Care, Family
- About How Many Hours
The questions your team needs answered
Every skilled nursing intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What type of nursing care is needed? | Care-type selections carry the heaviest weights — post-surgical care and IV therapy at 9 — so the intake flags clinically complex requests ahead of general or unclear needs. |
| Has a doctor ordered or recommended skilled nursing care? | A physician's-order answer of 'yes' (weight 9) marks a referral-ready case, while 'no' (weight 4) tells your team a doctor's order still needs to be obtained before scheduling. |
| Where will the care take place? | Segments the lead so you can route, price, and prioritize it correctly. |
| How soon is nursing care needed to begin? | Start-timing weights run from 10 for 'Immediately' to 2 for 'Just exploring options,' letting your team decide which enquiries get a same-day call. |
| Are you the person needing care, a family caregiver, or a care coordinator? | Knowing whether the submitter is the patient, a family caregiver, or a care coordinator tells your team who to contact for consent and history before the assessment. |
| About how many hours of nursing care per week are you expecting to need? | Expected weekly hours don't carry a score weight but give staffing coordinators an early read on whether the case needs occasional visits or continuous coverage. |
How Cliont scores skilled nursing leads
Every answer is weighted automatically — no manual review required.
Value signals
- Wound care
- Medication management
- Injections or IV therapy
- Monitoring vital signs or chronic conditions
- Post-surgical care
- Not sure
Urgency signals
- Immediately
See the lead your team receives
Skilled Nursing 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 skilled nursing workflows
| Cliont capability | Skilled Nursing application |
|---|---|
| Weighted multi-select scoring | Post-surgical care, IV therapy, and wound care selections carry higher weights than 'Not sure,' so clinically complex leads surface first in your CRM. |
| Conditional flagging | A 'no' answer on the physician's-order question is scored lower and can be flagged so your team follows up on securing a referral before booking a care assessment. |
| Urgency-based prioritization | Start-timing answers from 'Immediately' to 'Just exploring options' let your team call the most time-sensitive skilled nursing enquiries first. |
| Document collection | Physician's orders and discharge paperwork are collected during intake so the assessment can be scheduled without chasing documentation afterward. |
Common skilled nursing lead scenarios
Post-surgical care, doctor-ordered
A family reports a physician-ordered need for post-surgical care starting immediately — the highest-weighted combination the intake can flag for same-day follow-up.
Family still exploring options
Someone selects 'Not sure' for care type and 'Just exploring options' for timing, so the lead is captured with lower urgency for a longer-term nurture sequence instead of an immediate call.
Facility resident needs monitoring
A care coordinator at a senior living facility requests vital-sign monitoring for a resident, letting the intake route the location and referral source differently than a private-home request.
Referral without a physician order yet
A family caregiver wants skilled nursing but hasn't secured a doctor's order, which the intake scores lower than an ordered case and flags so your team can help get the referral in place before scheduling.
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
Skilled Nursing lead-intake FAQs
What happens when a lead hasn't gotten a physician's order yet?
The intake still captures the request but scores it lower than an already-ordered case, so your team can see at a glance which leads need help securing a referral before an assessment can be scheduled.
Can the intake tell us which leads need care right away?
Yes — the start-timing question ranges from 'Immediately' down to 'Just exploring options,' so leads needing care right away surface ahead of longer-term inquiries.
Does the form clarify who is actually filling it out?
It asks whether the person submitting is the patient, a family caregiver, or a care coordinator, so your intake team knows who to call for consent, history, and paperwork.
What if the family doesn't know what type of nursing care is needed?
'Not sure' is a valid answer for the care-type question — it's still captured and routed, just flagged so a clinical team member can follow up to clarify the specific need.
How does the intake handle facility placements versus private homes?
It asks directly where care will take place — private home, senior living facility, or other — so requests can be routed to the right coordinator without changing how the lead scores.
Is this the same intake used for wound care or post-hospital care leads?
No — Wound Care and Post-Hospital Care are separate subservices with their own qualification questions, though a skilled nursing lead may mention wound care or post-surgical needs within this intake's care-type question.
Turn skilled nursing visitors into qualified patients
Give every skilled nursing visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.