Bereavement intake that captures grief-support needs up front
Every bereavement enquiry captures who's seeking support, whether the loss was connected to your hospice or palliative program, and what type of support they want — individual counseling, group sessions, or child-specific care — before it reaches your CRM. Families also indicate comfort with group settings so your team can match them to the right format from the start.
The exact intake your bereavement support leads complete
This is the real 5-question guided intake for Bereavement Support — the same flow your customers finish before you ever pick up the phone.
What a qualified bereavement support lead should tell you
Ongoing grief counseling and support offered to individuals, families, or groups following a death, whether or not the loss occurred under hospice or palliative care, used to route each family to individual counseling, group sessions, or child- and teen-specific support.
- Seeking Bereavement Support
- Loss Connected Hospice Or
- Long Ago Did Loss
- Support
- Comfortable Receiving Support In
The questions your team needs answered
Every bereavement support intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is seeking bereavement support? | Knowing whether the family, an individual, a group, or a care coordinator submitted the request determines who your team follows up with and whether the case needs institutional coordination. |
| Was the loss connected to hospice or palliative care services? | A yes signals the loss occurred within your own hospice or palliative program, which typically points toward included bereavement services rather than an external referral, and carries the highest weight in the catalog. |
| How long ago did the loss occur? | The timeframe since the loss gives your bereavement team context on whether the family is in acute early grief or seeking longer-term support, shaping which counselor or program fits best. |
| What type of support are you looking for? | The specific support types selected determine which clinician or program the lead should be routed to, and selecting multiple types signals broader, higher-value needs. |
| Are you comfortable receiving support in a group setting with other grieving individuals? | Comfort with group settings determines whether the family should be matched to a support group or steered toward one-on-one counseling instead. |
How Cliont scores bereavement support leads
Every answer is weighted automatically — no manual review required.
Value signals
- Loss Connected Hospice Or: yes
- Individual grief counseling
- Group support sessions
- Support for a grieving child or teen
- Referrals to community resources
Disqualifiers
- Not sure yet
See the lead your team receives
Bereavement Support 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 bereavement support workflows
| Cliont capability | Bereavement Support application |
|---|---|
| Conditional question logic | If a family selects support for a grieving child or teen, the intake can flag that response for specialized clinician review instead of the general grief-counseling queue. |
| Weighted lead scoring | Whether the loss was connected to your hospice or palliative program carries more scoring weight than an unconnected loss, helping prioritize families likely eligible for included bereavement benefits. |
| Multi-select intake fields | Families can select several support types at once — individual counseling, group sessions, child support, referrals — and each selection contributes to how the lead is scored and where it's routed. |
| Automated CRM routing | A family that indicates discomfort with group settings can be routed to individual-counseling staff automatically, rather than defaulting to whichever program was requested first. |
Common bereavement support lead scenarios
Recent loss tied to your hospice
A family member lost someone within the past month and the death occurred while under your hospice's care, pointing toward included bereavement benefits and individual counseling.
Care coordinator referring a client
A coordinator submits on behalf of a client rather than the family submitting directly, which changes who your team follows up with and how the case gets documented.
Grieving child or teen
The request specifically flags support for a grieving child or teen, which typically needs a different clinician or program than adult individual counseling.
Loss unconnected to your program
The death wasn't tied to your hospice or palliative services and the family is mainly asking for referrals to community resources, which may route to a lighter-touch response than a full assessment.
Interested in support but not group-ready
A family selects group support sessions as a support type but indicates they aren't comfortable in a group setting, signaling they should be steered toward one-on-one counseling instead.
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 hospice and palliative care intake templates
Bereavement Support lead-intake FAQs
Does the intake tell us if a loss happened under our own hospice care?
Yes — the intake asks directly whether the loss was connected to hospice or palliative care services, which helps your team see whether the family may qualify for bereavement support included as part of your program versus needing an external referral.
Can the intake distinguish between someone wanting individual counseling versus a support group?
Yes — families select from specific support types including individual grief counseling, group sessions, child/teen support, and community referrals, so you know which program to route them to before your team ever calls.
How does the intake handle a care coordinator submitting on behalf of a family?
The intake asks who is seeking support, with an option for a care coordinator acting on a client's behalf, so your team knows to coordinate with the referring professional rather than the grieving family directly.
Do you ask how recently the loss occurred?
Yes — the intake captures whether the loss happened within the past month, up to a year, or longer ago, giving your bereavement team context on whether the family may be in acute early grief or looking for longer-term support.
What if a family isn't comfortable in a group setting?
The intake asks directly whether the family is comfortable receiving support alongside other grieving individuals, so a family that selects group sessions but says no can still be matched to individual counseling instead.
What happens if a family says they're 'not sure yet' what kind of support they need?
It's still a valid lead — 'not sure yet' is one of the support-type options, and the request is still scored and sent to your CRM so your team can follow up and help the family figure out the right fit.
How is this different from your Family Caregiver Support intake?
Family Caregiver Support is built for families managing an ongoing caregiving role, while this intake is specifically for grief and loss after a death, whether or not that death was connected to your hospice or palliative program.
Turn bereavement support visitors into qualified patients
Give every bereavement support visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.