Turn memory care placement enquiries into care assessment-ready leads
Ask about diagnosis status, current living situation, and safety concerns like wandering or medication trouble before you ever schedule a tour, so your team knows whether this family needs placement now or is still exploring options. Care records and legal authority documentation come in with the lead, not after the first call.
The exact intake your memory care placement leads complete
This is the real 6-question guided intake for Memory Care Placement — the same flow your customers finish before you ever pick up the phone.
What a qualified memory care placement lead should tell you
Matching a person living with dementia or memory loss to an appropriate residential memory care community, based on diagnosis status, current living situation, timeline, and who holds legal authority to decide.
- Doctor Diagnosed Person With
- Current Living Situation Person
- Soon Placement Happen
- Have Legal Authority Make
- Behavioral Or Safety Concerns
- Geographic Area Should Placement
The questions your team needs answered
Every memory care placement intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Has a doctor diagnosed the person with dementia, Alzheimer's, or a similar memory condition? | A confirmed diagnosis usually means the family already knows placement is the direction they're heading, versus still needing to rule out other causes. |
| What is the current living situation of the person needing care? | Segments the lead so you can route, price, and prioritize it correctly. |
| How soon does placement need to happen? | How soon placement needs to happen separates crisis-driven inquiries that need same-week outreach from families building a shortlist for later. |
| Do you have legal authority to make care decisions for this person, such as power of attorney or guardianship? | Without power of attorney or guardianship in place, no one on the intake may actually be able to sign a placement agreement yet, which changes what your team can offer them next. |
| Which behavioral or safety concerns currently apply? | Wandering, aggression, and fall history point to the level of supervision and unit security a community needs to provide, not just whether placement is needed at all. |
| What geographic area should placement options be located in? | Captures the detail in the patient’s own words so you’re briefed before the first call. |
How Cliont scores memory care placement leads
Every answer is weighted automatically — no manual review required.
Value signals
- Doctor Diagnosed Person With: yes
- Within a month
- Within a few months
- Have Legal Authority Make: yes
- Wandering or getting lost
- Aggression or agitation
Urgency signals
- Immediately (days)
See the lead your team receives
Memory Care Placement 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 placement workflows
| Cliont capability | Memory Care Placement application |
|---|---|
| Weighted lead scoring | Combines the diagnosis answer, placement timeline, and legal authority answer into one score so an immediate, POA-confirmed inquiry ranks above a distant, exploratory one. |
| Conditional follow-up prompts | When a family answers no to having power of attorney or guardianship, the intake can be configured to surface guidance content instead of pushing straight to scheduling. |
| Multi-select behavioral capture | The wandering, aggression, falls, and medication-management options from the safety question let staff see acuity level before deciding which community tier to recommend. |
| CRM field mapping | The free-text geographic area answer is passed through to your CRM as a routable field, so leads can be assigned to the community or region that actually has availability. |
Common memory care placement lead scenarios
Crisis placement after a wandering incident
Diagnosis is confirmed, the person wandered or got lost recently, and the family needs placement within days with legal authority already in hand.
Discharge planning from hospital or rehab
The person is currently in a hospital or rehab facility with a placement deadline inside a month, often with medication management concerns flagged alongside the diagnosis.
Adult child researching for a parent at home
The person is still living alone or with family, no safety incidents yet, and the inquiry is marked as just exploring options rather than needing immediate placement.
Family without legal decision authority
A diagnosis is confirmed and urgency is real, but no one has power of attorney or guardianship yet, which changes what your team can act on before a tour.
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
Memory Care Placement lead-intake FAQs
Does the intake check whether the family can legally make placement decisions?
Yes, the form asks directly whether the person completing it holds power of attorney or guardianship, and that answer factors into how the lead is scored so your team knows before the first call whether a decision-maker is actually on the line.
What happens if the family hasn't gotten a formal dementia diagnosis yet?
The diagnosis question is still asked and scored lower without confirmation, so those leads still reach your CRM but are distinguishable from families with a documented diagnosis ready to act on.
Can the intake flag families whose loved one wanders or has had falls?
The behavioral and safety question captures wandering, aggression, falls, and medication trouble as separate selectable concerns, which lets your team see at a glance whether a secured or higher-acuity unit is likely needed.
How does the intake treat someone who's just exploring options for the future?
The placement timeline question includes a dedicated 'just exploring' option that scores lower than immediate or within-a-month needs, so those inquiries still land in your CRM without being mistaken for urgent placements.
What do you do with the geographic area a family enters?
The free-text location field isn't scored on its own, but it travels with the lead into your CRM so it can be routed to the right community or region without your staff having to ask again.
How is this different from your Memory Care Assessment intake?
Memory Care Placement intake is built for families ready to locate a community now, weighting diagnosis, timeline, and legal authority, while Memory Care Assessment is a separate sibling flow aimed earlier in the decision process.
Turn memory care placement visitors into qualified patients
Give every memory care placement visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.