Memory care intake that captures decision-maker status up front
Cliont's memory care assessment intake asks about the person's living situation, the severity of recent memory changes, and who holds legal decision-making authority — then flags safety-incident cases and routes decision-maker-confirmed families straight to your CRM.
Preview your memory care assessment intake
Explore 6 questions from the Memory Care Assessment template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified memory care assessment lead should tell you
An evaluation of a person's memory, cognition, and daily functioning used to determine what level of memory care support is appropriate, informed by the severity of changes observed, what triggered the request, current living situation, and who holds decision-making authority.
- This Assessment
- Best Describes Current Level
- Prompting This Assessment Now
- Person Live
- Legal Decision-Maker Or Primary
- Soon This Assessment Completed
The questions your team needs answered
Every memory care assessment intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this assessment for? | Distinguishing self, family, or professional coordinator lets staff tailor communication and consent handling before the assessment. |
| Which best describes the current level of memory-related changes observed? | The perceived severity of memory changes helps staff gauge how quickly a full assessment should be scheduled. |
| What is prompting the need for this assessment now? | This field carries the highest scoring weights in the catalog, so it's the primary driver of whether a lead is treated as urgent or exploratory. |
| Where does the person currently live? | Current living situation shows how much day-to-day support already exists, shaping what the assessment needs to evaluate. |
| Are you the legal decision-maker or primary caregiver for this person? | Confirming legal decision-making or caregiver status determines who can authorize next steps after the assessment. |
| How soon do you need this assessment completed? | The requested timeline separates families in active crisis from those still exploring options. |
How Cliont scores memory care assessment leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Noticeable recent decline in memory or behavior
- A safety incident occurred (falls, getting lost, etc.)
- Planning ahead for future care needs
- Routine checkup or general concern
- Legal Decision-Maker Or Primary: yes
- As soon as possible
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Memory Care Assessment 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 memory care assessment workflows
| Cliont capability | Memory Care Assessment application |
|---|---|
| Weighted urgency scoring | Automatically weights 'a safety incident occurred' and 'as soon as possible' answers highest, so post-fall or wandering cases surface above routine planning inquiries. |
| Decision-maker flagging | Flags whether the person completing the intake is the legal decision-maker or primary caregiver versus a care coordinator, so staff know who to loop in before the assessment call. |
| Living-situation context | Surfaces whether the person lives independently, with family, in assisted living, or in a nursing facility, so staff can prep the right assessment approach in advance. |
| Document collection | Collects medical records, medication lists, and power-of-attorney documentation upfront, cutting down on back-and-forth before scheduling. |
| CRM routing | Sends qualified assessment requests into your CRM with authority status and urgency attached, instead of a raw voicemail or email to sort through manually. |
Example memory care assessment lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Post-fall safety incident
A family reports a fall or wandering episode as the trigger and wants the assessment as soon as possible — the two highest-weighted answers in the catalog, so this lead surfaces first.
Planning ahead early
The person still lives independently and the family selects 'planning ahead for future care needs' with a 'within a few weeks' timeline — a lower-urgency but genuine assessment request.
Care coordinator inquiry
Someone completing the form on behalf of a client, not as the legal decision-maker, describes moderate changes — the intake flags the authority gap so staff know who else needs to be looped in.
General curiosity check-in
A caller marks 'routine checkup or general concern' and 'just exploring options,' the lowest-weighted combination, so it's logged without triggering urgent follow-up.
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 memory care intake templates
Memory Care Assessment lead-intake FAQs
How does the intake tell a crisis apart from a routine planning inquiry?
The 'what's prompting the need for this assessment now' question carries the highest weight in the catalog — a safety incident or noticeable decline scores far above planning ahead or a routine checkup, and that combines with the requested timeline to prioritize the lead.
What happens when the person filling out the form isn't the legal decision-maker?
The intake asks directly whether the submitter is the legal decision-maker or primary caregiver, and a 'no' answer scores lower than a 'yes' — this doesn't disqualify the lead but flags that staff may need to confirm who can authorize next steps before scheduling.
Does the form capture where the person currently lives before we call?
Yes — the intake records whether they live independently, with family, in assisted living, or in a nursing facility, so your team can gauge existing support before the assessment call.
Can the intake distinguish self-inquiries from family or care-coordinator submissions?
The first question asks who the assessment is for — self, a family member, or a client the submitter coordinates care for — which shapes how staff approach consent and communication.
What documentation should families upload with the assessment request?
Cliont can collect recent medical or diagnostic records, a current medication list, and power-of-attorney or guardianship documentation upfront, so staff aren't chasing paperwork after the family has already reached out.
How is this different from the intake used for Memory Care Placement?
This subservice's questions focus on evaluating the person's current condition and living situation to determine if an assessment is warranted, while Memory Care Placement and In-Home Memory Support intakes assume the assessment stage has passed and focus on logistics instead.
Turn memory care assessment visitors into qualified patients
Give every memory care assessment visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.