Palliative care intake that captures decision-making authority up front
Every submission captures diagnosis status, current physician involvement, and who holds decision-making authority, along with diagnosis documentation or an advance directive if the family has one, so your intake team knows exactly what's needed before scheduling a care assessment.
Preview your palliative care consultation intake
Explore 7 questions from the Palliative Care Consultation template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified palliative care consultation lead should tell you
A consultation where a family or care coordinator discusses comfort-focused symptom management and care planning for someone with a diagnosed serious or chronic illness, alongside their existing medical treatment.
- This Consultation
- Person Have Diagnosed Serious
- Main Reason Seeking This
- Person Under Care Treating
- Person Receive Care
- Soon This Consultation Take
- Have Authority Make Care
The questions your team needs answered
Every palliative care consultation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this consultation for? | Distinguishes self-inquiries and family referrals from professional care-coordinator referrals, which often need different intake handling and follow-up. |
| Does the person have a diagnosed serious or chronic illness? | A confirmed diagnosis carries the heaviest scoring weight because palliative consultations are built around managing a known serious or chronic condition. |
| What is the main reason for seeking this consultation? | The stated reason for seeking consultation — pain management, planning, or emotional support — helps route the lead to the right clinician or care coordinator. |
| Is the person currently under the care of a treating physician? | Knowing whether a treating physician is already involved tells your team whether this consultation needs to coordinate with existing treatment or start care planning independently. |
| Where does the person currently receive care? | Segments the lead so you can route, price, and prioritize it correctly. |
| How soon do you need this consultation to take place? | Stated timing tells your scheduling team how quickly to respond without needing to infer urgency from a free-text description. |
| Do you have authority to make care decisions or arrangements for this person? | Decision-making authority is weighted heavily because a consultation can't move to scheduling until someone authorized to arrange care is engaged. |
How Cliont scores palliative care consultation leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Person Have Diagnosed Serious: yes
- Person Under Care Treating: yes
- Have Authority Make Care: yes
Disqualifiers
- Not sure yet
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Palliative Care Consultation 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 palliative care consultation workflows
| Cliont capability | Palliative Care Consultation application |
|---|---|
| Weighted scoring engine | Applies the catalog's heaviest weights to diagnosed illness, treating physician involvement, and decision-making authority so leads missing all three surface lower than families with a confirmed diagnosis and an authorized decision-maker. |
| Guided branching intake | Separates 'myself,' 'family member,' and 'client I coordinate care for' at the first question so professional referrals are tagged differently from direct family inquiries from the start. |
| Document collection | Requests diagnosis documentation and advance directive paperwork alongside the questionnaire so clinical staff have context before the first assessment call. |
| CRM routing | Sends qualified consultations — those with confirmed diagnosis, physician involvement, and decision authority — directly into your CRM instead of a shared inbox. |
Example palliative care consultation lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Diagnosed patient, decision-maker ready
A family member confirms a diagnosed chronic illness, an engaged treating physician, and their own authority to arrange care — the highest-weighted combination the intake can flag for a direct care assessment.
Care coordinator without authority
A professional coordinator submits on behalf of a client but answers no to holding decision-making authority, so the intake still records the details while signaling that a family decision-maker needs to be brought in before scheduling.
Exploring options, no diagnosis yet
Someone inquires for themselves with no confirmed diagnosis and selects 'not sure yet' as the reason, giving your team a lower-weighted lead to route to an informational call rather than a full consultation.
Facility resident needing fast turnaround
A nursing facility resident's family selects symptom management as the reason and wants a consultation within a few days, letting staff prioritize scheduling around the stated timing even though timing itself isn't a scored field.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
Lawmatics, MyCase, Clio Manage and Clio Grow
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 hospice and palliative care intake templates
Palliative Care Consultation lead-intake FAQs
How does the intake identify who can actually arrange care?
One catalog question asks directly whether the person submitting has authority to make care decisions, and it carries one of the heaviest weights in the scoring model — a yes answer signals a lead that can move straight to scheduling, while a no answer flags that a decision-maker still needs to be looped in.
What happens if the person doesn't have a confirmed diagnosis yet?
The intake still accepts the submission and records the answer, but a 'no' on diagnosis status is weighted much lower than a confirmed diagnosis, so your team can see at a glance that this lead may need more information before a full consultation is appropriate.
Can care coordinators or professionals submit consultations on behalf of a client?
Yes — the first intake question lets the submitter identify themselves as the patient, a family member, or a professional coordinating care, so those referrals are captured distinctly from direct family inquiries.
Does the intake ask how soon the family needs the consultation?
Yes, families choose from options ranging from within a few days to just exploring options, which gives your scheduling team context on timing even though this field isn't part of the core fit-scoring logic.
How is this different from your Hospice Eligibility Assessment intake?
This intake is built around comfort-focused planning alongside ongoing treatment and doesn't ask about prognosis or terminal status the way a Hospice Eligibility Assessment intake would — the two are meant for different points in a family's care journey.
What if the treating physician isn't confirmed yet?
The intake still captures the lead, but a 'no' on physician involvement is weighted lower than a confirmed treating physician, since that answer affects whether your team needs to coordinate with an existing provider or start care planning independently.
Turn palliative care consultation visitors into qualified patients
Give every palliative care consultation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.