Personal care intake that asks what your team actually needs to know
Every enquiry captures which personal care tasks are needed — bathing, toileting, mobility, or medication reminders — along with a current medication list, so you know what a family needs before you schedule a care assessment.
The exact intake your personal care assistance leads complete
This is the real 5-question guided intake for Personal Care Assistance — the same flow your customers finish before you ever pick up the phone.
What a qualified personal care assistance lead should tell you
Hands-on daily living support for older adults, covering tasks like bathing, dressing, toileting, mobility transfers, eating assistance, and medication reminders in the home.
- Personal Care Tasks Older
- Often Personal Care Assistance
- Soon Care Needed Begin
- Older Adult Live
- Authorized Arrange Care Services
The questions your team needs answered
Every personal care assistance intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Which personal care tasks does the older adult need help with? | Toileting or continence care and mobility transfers carry the highest weights because they demand the most hands-on skill, so selecting them pushes a lead toward higher priority. |
| How often is personal care assistance needed? | Daily or several-times-a-week frequency signals an ongoing staffing commitment rather than a one-off visit, which affects how quickly you schedule the assessment. |
| How soon is care needed to begin? | An 'Immediately' answer carries the top weight, letting your team spot leads that need a care assessment scheduled right away versus families just exploring options. |
| Where does the older adult currently live? | Knowing whether the older adult is at home, with family, or already in a facility changes what your assessment needs to cover and whether the setting fits your service. |
| Are you authorized to arrange care services on behalf of the older adult? | A 'no' here scores lower than a 'yes,' surfacing leads where your team should confirm who actually has authority to arrange and approve care before booking time. |
How Cliont scores personal care assistance leads
Every answer is weighted automatically — no manual review required.
Value signals
- Bathing or grooming
- Dressing
- Toileting or continence care
- Mobility or transfers
- Eating assistance
- Medication reminders
Urgency signals
- Immediately
See the lead your team receives
Personal Care Assistance 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 personal care assistance workflows
| Cliont capability | Personal Care Assistance application |
|---|---|
| Weighted lead scoring | Toileting or continence care and mobility transfers carry the highest weights of any task, so leads needing that level of support automatically score above simpler dressing-only requests. |
| Disqualifier / verification flags | A 'no' answer on authorization to arrange care is scored lower, prompting your team to confirm decision-making authority before booking a care assessment. |
| Document capture | Medication lists and physician or care-plan notes attach directly to the lead record, so your team reviews the same file before ever calling the family. |
| Structured routing to CRM | Frequency, start timing, and living situation answers arrive as structured fields in your CRM instead of a paragraph you have to parse from a voicemail. |
Common personal care assistance lead scenarios
Daily hands-on care needed
Family selects toileting, mobility transfers, and bathing help needed every day, with care to start immediately — the intake flags this as a high-need, time-sensitive lead.
Occasional check-in request
Only dressing help is selected, frequency is occasional or as-needed, and the family is still exploring options — a lighter-touch lead that still routes to your CRM for follow-up.
Inquiry from an unauthorized relative
A concerned family member answers on someone else's behalf without authorization to arrange services, which the intake flags so your team can confirm decision-making authority before booking an assessment.
Move-out from assisted living
The older adult currently lives in an assisted living facility but the family wants added 1:1 support for mobility and eating assistance — a different setup than an in-home-only case.
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
Personal Care Assistance lead-intake FAQs
How does this intake tell personal care assistance apart from companion care leads?
The intake asks directly which hands-on tasks are needed — bathing, toileting, mobility transfers, or eating assistance. If a family only needs supervision or social engagement with none of those tasks selected, that's a better fit for Companion Care and can be routed accordingly.
What happens if the family isn't sure how often care is needed?
The frequency question includes an occasional or as-needed option, so uncertain families still get scored and delivered to your CRM rather than dropped from the funnel.
How does the intake handle someone who isn't authorized to arrange care?
The authorization question carries a lower weight when the answer is no, so those leads still reach you but are flagged for verification before you commit assessment time.
Can the intake tell if a family might actually need overnight or live-in coverage instead?
When daily frequency is paired with multiple high-weight tasks like toileting and mobility transfers, that combination signals heavier need, which is a useful cue to also discuss Overnight Care or Live-In Care during the assessment.
What shows up in my CRM before I schedule a care assessment?
You get the specific tasks selected, how often care is needed, when it should start, the older adult's living situation, and whether the inquirer is authorized to arrange care, along with any medication list or care notes they uploaded.
Does the intake capture whether the older adult lives at home or in a facility?
Yes, the living situation question distinguishes between own home, a family member's home, independent living, or assisted living, so you can judge whether your service fits the setting before the assessment.
Turn personal care assistance visitors into qualified patients
Give every personal care assistance visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.