Know which in-home memory support leads are worth a care assessment
The intake captures the level of memory-related challenge, weekly hours needed, and legal authority to arrange care, plus POA documentation, so your team assesses only families whose needs match what you actually provide.
The exact intake your in-home memory support leads complete
This is the real 6-question guided intake for In-Home Memory Support — the same flow your customers finish before you ever pick up the phone.
What a qualified in-home memory support lead should tell you
In-home care for someone experiencing memory-related decline, covering the level of cognitive impairment, the specific support tasks needed (supervision, medication reminders, mobility help), and weekly hours of coverage required, delivered in the person's own residence.
- This Support
- Level Memory-Related Challenge Best
- Support Needed
- Many Hours In-Home Support
- Have Legal Authority Arrange
- Soon In-Home Support Begin
The questions your team needs answered
Every in-home memory support intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this support for? | Knowing whether the requester is the care recipient, a family member, or a professional coordinator changes who needs to be looped in for consent before you schedule an assessment. |
| What level of memory-related challenge best describes the situation? | Severity of memory-related challenge is directly weighted, so wandering-risk cases surface above mild-forgetfulness cases in your CRM. |
| What type of support is needed? | Multi-select support types let your team pre-match caregiver skills, like overnight coverage versus medication reminders, before the first call. |
| How many hours of in-home support are needed per week? | Hours-needed indicates staffing intensity, so a request for round-the-clock support is treated as a different care model than a few hours per week. |
| Do you have legal authority to arrange care for this person? | A confirmed yes on legal authority scores notably higher than a no, since it signals someone can actually execute a care agreement. |
| How soon do you need in-home support to begin? | Timing separates a same-day wandering-risk request from a family still comparing options, letting your team prioritize response order. |
How Cliont scores in-home memory support leads
Every answer is weighted automatically — no manual review required.
Value signals
- Mild forgetfulness, mostly independent
- Moderate confusion, needs daily reminders
- Significant disorientation or wandering risk
- Not sure
- Have Legal Authority Arrange: yes
- Within two weeks
Urgency signals
- Immediately
Disqualifiers
- Not sure yet
See the lead your team receives
In-Home Memory 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 in-home memory support workflows
| Cliont capability | In-Home Memory Support application |
|---|---|
| Weighted lead scoring | Combines the memory-challenge severity answer with the start-timing answer, so a wandering-risk case marked 'immediately' scores well above a mild-forgetfulness case still exploring options. |
| Multi-select intake fields | The support-type question lets families check companionship, medication reminders, mobility assistance, or overnight care together, giving your team a staffing profile before the assessment. |
| Conditional routing on authority signals | A 'no' answer on legal authority to arrange care routes the lead into your CRM with a lower initial weight, prompting a verification step rather than a same-day booking. |
| CRM delivery with structured fields | Hours-needed and support-type answers arrive as structured data in your CRM, so staff can pre-match a caregiver skill set before the family's first assessment call. |
Common in-home memory support lead scenarios
Wandering risk, needs care now
A family selects significant disorientation or wandering risk and immediate start, which combines two of the highest-weighted signals in the catalog to push the lead straight to the top of the queue.
Care coordinator without legal authority
A professional care coordinator submits the form on behalf of a client but hasn't confirmed power of attorney, so the lower-weighted answer to the legal authority question flags it for a verification step before scheduling.
Mild forgetfulness, a few hours weekly
The family describes mild forgetfulness and only needs a few hours of support per week, a lighter-intensity request that still qualifies but reads differently than a wandering-risk case.
Round-the-clock support, still exploring
A family asks about round-the-clock support but marks timing as just exploring options, showing high staffing need paired with low urgency so your team can plan outreach without treating it as same-day.
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
In-Home Memory Support lead-intake FAQs
How does the intake handle families who aren't sure who holds power of attorney?
The legal authority question is a simple yes/no, and a 'no' answer is weighted lower than a confirmed 'yes,' so those leads still reach your CRM but can be flagged for a verification step before you schedule a care assessment.
Can one submission capture multiple support needs, like medication reminders and overnight care together?
Yes, the support-type question is multi-select, so a family can indicate companionship, medication reminders, and overnight care in a single response, giving your team a fuller picture before the first call.
How are leads scored when a family says they're 'just exploring options' versus needing care immediately?
Timing is weighted, with 'immediately' scoring higher than 'just exploring,' so urgent cases surface faster in your CRM while early-stage inquiries are still captured for follow-up.
Does the intake distinguish between someone arranging their own care and a professional care coordinator?
Yes, the first question asks whether the support is for the requester, a family member, or a client they coordinate care for, which helps your team understand who to loop in for consent and decision-making.
What happens if a family isn't sure how severe the memory-related challenge is?
'Not sure' is a valid option on the severity question and still carries a moderate weight, so uncertain families aren't excluded, they're simply scored against a lower baseline than a confirmed wandering-risk case.
Is In-Home Memory Support intake different from your Memory Care Assessment or Memory Care Placement pages?
Yes, this catalog is specific to in-home hours, support tasks, and legal authority for ongoing care in the person's residence, while Memory Care Assessment and Memory Care Placement ask different qualifying questions suited to those services.
Turn in-home memory support visitors into qualified patients
Give every in-home memory support visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.