Behavioral support intake that asks what your team actually needs to
Ask which behaviors are causing concern, how often they occur, and whether there's any risk of harm — then let families upload video of an episode so your team can assess fit before scheduling a care assessment.
The exact intake your behavioral support leads complete
This is the real 5-question guided intake for Behavioral Support — the same flow your customers finish before you ever pick up the phone.
What a qualified behavioral support lead should tell you
Intake for families managing dementia-related behaviors — aggression, wandering, agitation, paranoia, or sundowning — who need to know whether a memory care team can safely support the person and how urgently.
- Behaviors Most Concerned About
- Person Live
- Often These Behaviors Occur
- Primary Decision-Maker This Person'S
- There Any Current Risk
The questions your team needs answered
Every behavioral support intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Which behaviors are you most concerned about? | Behaviors like aggression or wandering carry more immediate safety implications than repetitive questioning, so weighting them heavier surfaces leads that need specialized attention sooner. |
| Where does the person currently live? | Segments the lead so you can route, price, and prioritize it correctly. |
| How often do these behaviors occur? | Daily episodes signal an escalating situation that warrants a faster care assessment than a behavior that's only occurred occasionally. |
| Are you the primary decision-maker for this person's care? | If the respondent isn't the decision-maker, your team may need to loop in whoever actually approves care before scheduling an assessment. |
| Is there any current risk of harm to the person or others from these behaviors? | Any indication of risk to the person or others should override routine scheduling and move the lead to the top of the queue. |
How Cliont scores behavioral support leads
Every answer is weighted automatically — no manual review required.
Value signals
- Aggression or hitting
- Wandering or exit-seeking
- Agitation or restlessness
- Paranoia or suspicion
- Repetitive questions or actions
- Other behavior
Urgency signals
- Sundowning (evening confusion)
See the lead your team receives
Behavioral 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 behavioral support workflows
| Cliont capability | Behavioral Support application |
|---|---|
| Weighted multi-select scoring | Aggression and wandering answers push a lead's score up faster than lower-risk behaviors like repetitive questioning, so your team sees severity at a glance. |
| Conditional branching by living situation | A response of 'at home alone' can be routed differently than 'assisted living community,' since the safety urgency and next step aren't the same. |
| Risk-flag escalation | A yes on the risk-of-harm question can trigger immediate notification so it isn't waiting behind lower-urgency behavioral inquiries in the CRM queue. |
| Guided media upload | Families can attach video of a behavioral episode directly in the intake, giving your team context before they commit to an in-person care assessment. |
Common behavioral support lead scenarios
Daily aggression with risk of harm
A spouse reports daily hitting episodes and confirms risk of harm — the intake flags this as high priority so it doesn't sit in a queue behind lower-urgency inquiries.
Wandering while living alone
A daughter describes exit-seeking behavior in a parent who lives alone, a combination that raises safety concerns even without aggression, and the intake scores it accordingly.
Occasional repetitive questions
A family exploring options early reports rarely-occurring repetitive questioning with no risk of harm — the intake still captures it, but scores it lower than an active safety situation.
Sundowning inside assisted living
A resident in assisted living shows evening confusion a few times a week; because they're already in a care setting, the intake routes this differently than an at-home inquiry.
Inquiry from a non-decision-maker
A concerned neighbor or distant relative submits the form but isn't the person who can approve care — the intake flags this so staff know to confirm decision-making authority 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 memory care intake templates
Behavioral Support lead-intake FAQs
What happens if a family answers yes to risk of harm?
The intake weights that answer heavily regardless of how the other questions are answered, so any indication of risk to the person or others surfaces the lead as high priority for your team's review.
Does it matter if the person filling out the form isn't the decision-maker?
Yes — the intake asks directly whether the respondent is the primary decision-maker, and answers of 'no' are weighted lower so your team knows to confirm who actually approves the care plan before investing assessment time.
How does this intake differ from your Memory Care Placement or In-Home Memory Support pages?
This one is built around behavior severity and frequency rather than facility search or in-home staffing needs, though the current-living-situation question helps distinguish which of those paths a family may actually need next.
What video or documents should families upload?
We recommend requesting video of a recent behavioral episode where available, since it gives your team a clearer picture of severity than a written description alone, alongside any current care plan or medication list.
Why do aggression and wandering score higher than repetitive questions?
Those behaviors carry more immediate safety and staffing implications, so the catalog weights them heavier than lower-risk patterns like repeated questions, which still get captured but don't push the lead to the top of the queue.
Can frequency of behavior change how a lead is prioritized?
Yes — daily occurrences are weighted higher than occasional or rare ones, so a family dealing with an escalating daily pattern is distinguished from one that's monitoring an early, infrequent change.
Turn behavioral support visitors into qualified patients
Give every behavioral support visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.