Companion care intake that asks what your team actually needs to know
Every companion care enquiry captures the type of support needed, when care should start, and whether the person needs help getting in and out of chairs, plus authorization details, before it reaches your CRM.
The exact intake your companion care leads complete
This is the real 7-question guided intake for Companion Care — the same flow your customers finish before you ever pick up the phone.
What a qualified companion care lead should tell you
Companion care covers conversation, social engagement, light supervision, and accompaniment for an older adult who does not need hands-on medical or personal care tasks.
- This Care Primarily Needed
- Support Mainly Needed
- Soon Companion Care Needed
- Person Help Getting In
- Authorized Arrange Care Services
- Many Days Per Week
- Person Live Alone
The questions your team needs answered
Every companion care intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this care primarily needed for? | Identifies whether you're speaking with the care recipient, a family decision-maker, or a professional coordinator, which changes who to follow up with and how. |
| What type of support is mainly needed? | A selection of hands-on medical or nursing tasks scores far lower than social engagement or supervision, surfacing leads that may not actually fit companion care. |
| How soon is companion care needed to begin? | Separates families needing care to start immediately from those still exploring, so urgent requests aren't buried behind casual inquiries. |
| Does the person need help getting in and out of chairs or walking? | Signals whether the assigned caregiver needs experience assisting with transfers or walking before the first visit. |
| Are you authorized to arrange care services on this person's behalf? | Determines whether staff can move straight to scheduling an assessment or need to confirm decision-making authority first. |
| How many days per week is companion care needed? | Segments the lead so you can route, price, and prioritize it correctly. |
| Does the person currently live alone? | Flags whether the person has regular support at home, which affects how staffing and check-in frequency should be planned. |
How Cliont scores companion care leads
Every answer is weighted automatically — no manual review required.
Value signals
- Conversation and social engagement
- Light supervision for safety
- Accompaniment to outings or errands
- Participation in hobbies or activities
- Within 2 weeks
- Within a month
Urgency signals
- Immediately
Disqualifiers
- Not sure yet
See the lead your team receives
Companion Care Lead - Daily Support for Parent Living Alone
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 companion care workflows
| Cliont capability | Companion Care application |
|---|---|
| Automatic lead scoring | Flags submissions that select hands-on medical or nursing tasks so staff can review whether the request actually fits companion care before scheduling. |
| CRM routing rules | Sends leads marked 'immediately' or 'within 2 weeks' to a priority queue so same-week assessments get scheduled ahead of exploratory inquiries. |
| Structured field capture | Records the authorization answer directly on the lead record so staff know whether to request documentation before finalizing an assessment date. |
| Multi-select tagging | Uses the support-type selections to tag leads by need (conversation, supervision, outings, hobbies) so assessments can be prepped with the right caregiver profile in mind. |
| Conditional follow-up prompts | Uses the mobility and living-alone answers together to surface leads that may need a caregiver with transfer experience or more frequent check-ins. |
Common companion care lead scenarios
Immediate start, social engagement only
A family picks conversation and light supervision with an immediate start date, landing as a high-priority lead ready for same-week assessment scheduling.
Just exploring options
Someone selects the lowest-weighted timing option to browse without commitment, so the intake still captures details but routes it for lighter, non-urgent follow-up.
Request includes hands-on medical tasks
A submission flags hands-on nursing or medical support alongside companionship needs, which the intake surfaces as a service mismatch worth redirecting to Personal Care Assistance.
Care coordinator, unclear authorization
A professional care coordinator submits the form on a client's behalf and answers 'no' to being authorized to arrange services, prompting a confirmation step before booking an assessment.
Living alone, daily accompaniment needed
The recipient lives alone, needs help walking, and requires daily support, combining safety and mobility signals that inform staffing and how the assessment should be scheduled.
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 non-medical home care intake templates
Companion Care lead-intake FAQs
How does the intake catch leads that actually need medical or nursing care, not companionship?
The support-type question includes a 'hands-on medical or nursing tasks' option weighted far lower than social engagement or supervision options, so those responses stand out and can be routed toward a service that actually covers clinical care.
What happens if the person filling out the form isn't authorized to arrange care for their family member?
The authorization question is scored separately from timing and support needs, so a 'no' answer doesn't disqualify the lead but flags it for a quick confirmation step before an assessment is booked.
Can the intake tell us how soon a family actually needs care to start?
Yes, the start-timing question separates 'immediately' and 'within 2 weeks' from 'just exploring options,' so urgent requests can be prioritized ahead of casual inquiries.
Does the form flag mobility or fall-risk concerns before the first visit?
The intake asks directly whether the person needs help getting in and out of chairs or walking, so your team knows before the assessment whether extra caution or experience with transfers is needed.
How do you handle leads where the person lives alone versus with family?
The living-alone question is captured on every lead so staff have context on daily supervision gaps and can factor that into how frequently companion visits should occur.
What if a family isn't sure yet how many days per week they'll need care?
The frequency question includes a 'not sure yet' option so the lead still comes through complete, and your team can use the assessment to help the family scope out a schedule.
Turn companion care visitors into qualified patients
Give every companion care visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.