Caregiver support intake that flags who needs help fastest
Families share their relationship to the patient, current hospice enrollment status, and whether they need respite care, emotional support, or help coordinating tasks, while uploading authorization documentation so your team knows exactly who they're assessing before the first call.
The exact intake your family caregiver support leads complete
This is the real 6-question guided intake for Family Caregiver Support — the same flow your customers finish before you ever pick up the phone.
What a qualified family caregiver support lead should tell you
Intake for families seeking help managing the demands of caring for a hospice or palliative patient, covering who the caregiver is, their decision-making authority, and what kind of relief or coordination they need most.
- Relationship Person Receiving Hospice
- Patient Enrolled In Hospice
- Support Caregiver Most Right
- Would Describe Caregiver'S Current
- Authorized Make Care Decisions
- Soon Caregiver Support Services
The questions your team needs answered
Every family caregiver support intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is your relationship to the person receiving hospice or palliative care? | Segments the lead so you can route, price, and prioritize it correctly. |
| Is the patient currently enrolled in a hospice or palliative care program? | Whether the patient is already enrolled in hospice or palliative care shifts what kind of caregiver support is even appropriate to offer right now. |
| What kind of support does the caregiver need most right now? | The specific support type requested determines which staff member or resource the lead should be routed to, from respite scheduling to a counseling referral. |
| How would you describe the caregiver's current level of daily involvement? | A near-full-time primary caregiver is at higher risk of burnout and typically needs a faster response than someone providing occasional or remote support. |
| Are you authorized to make care decisions or requests on behalf of the patient? | Confirming decision-making authority upfront prevents your team from scheduling a care assessment with someone who can't actually authorize the services discussed. |
| How soon do you need caregiver support services to begin? | The requested start timeline separates caregivers who need relief this week from those still researching, which changes how fast your team needs to follow up. |
How Cliont scores family caregiver support leads
Every answer is weighted automatically — no manual review required.
Value signals
- Patient Enrolled In Hospice: yes
- Emotional support or counseling referral
- Respite care or short-term relief
- Help coordinating care tasks and schedules
- Education on caregiving skills or symptom management
- Connection to a caregiver support group
Urgency signals
- Immediately
See the lead your team receives
Family Caregiver 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 family caregiver support workflows
| Cliont capability | Family Caregiver Support application |
|---|---|
| Weighted scoring logic | Ranks caregivers who are primary, near-full-time carers requesting respite or emotional support above those doing occasional or remote coordination, so your team sees who needs relief soonest. |
| Conditional routing rules | Flags leads where the caregiver is not authorized to make care decisions, so your intake team can verify decision-making authority before scheduling a care assessment. |
| Urgency tagging | Surfaces caregivers who selected 'Immediately' for support start-time above those still exploring options, without discarding the exploratory leads entirely. |
| Multi-select need capture | Lets a single caregiver flag several support types at once, such as respite care and a caregiver support group referral, so your team can route to more than one resource in one pass. |
Common family caregiver support lead scenarios
Primary caregiver near burnout
A spouse providing near-full-time care flags respite care and emotional support as top needs and wants help to start immediately, so the intake pushes this to the front of the queue.
Adult child coordinating remotely
A long-distance adult child is only handling remote coordination and requests help scheduling care tasks within the month, a lower-urgency mix your team can plan around rather than react to.
Spouse not yet hospice-enrolled
A caregiver who is authorized to make decisions but reports the patient isn't yet in a hospice program signals a need that may sit outside pure caregiver support until enrollment is resolved.
Care coordinator referring a family
A professional care coordinator submits on behalf of a family needing several support types at once, letting your team see the full request instead of triaging fragmented follow-up calls.
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
Family Caregiver Support lead-intake FAQs
Does the intake tell us if the patient is already enrolled in hospice or palliative care?
Yes, the form asks directly whether the patient is currently enrolled, which carries meaningful weight since caregiver support needs differ significantly for enrolled versus not-yet-enrolled families.
How does the intake handle a caregiver who isn't the legal decision-maker?
The form asks whether the person completing it is authorized to make care decisions or requests on the patient's behalf, so your team can flag any lead where that authority is unclear before scheduling a care assessment.
Can the intake separate an urgent respite request from someone just researching options?
It combines the requested support type with the stated timeline, so a caregiver asking about respite care who needs it immediately scores very differently from one exploring options for the future.
What happens if a caregiver isn't sure what kind of help they need?
"Not sure" is a valid answer on the support-needs question, and those leads still get scored and routed rather than dropped, just with a lower weight than a specific request like counseling or respite care.
Does the form distinguish a primary caregiver from someone helping occasionally?
Yes, the involvement-level question separates near-full-time primary caregivers from shared, occasional, or remote support roles, which affects how urgently your team should respond.
Can more than one family member submit an intake for the same patient?
The relationship question captures who is submitting, so if a spouse and an adult child both come in for the same patient your team can see the full picture instead of two disconnected leads.
Turn family caregiver support visitors into qualified patients
Give every family caregiver support visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.