Know which respite care leads are worth care assessment time
Cliont's respite care intake asks who the care is for, what daily support they currently need, and how often coverage is needed, then verifies the requester's authority to arrange care before anything lands in your CRM.
Preview your respite care intake
Explore 6 questions from the Respite Care template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified respite care lead should tell you
Short-term, scheduled in-home care that gives an unpaid family caregiver a planned break while the older adult receives supervision, personal care, or mobility support in their place.
- This Care Primarily
- Daily Support Person
- Often Would Like Respite
- There Current Family Or
- Legally Authorized Arrange Care
- Will Respite Care Take
The questions your team needs answered
Every respite care intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this care primarily for? | Segments the lead so you can route, price, and prioritize it correctly. |
| What kind of daily support does the person currently need? | Personal care and mobility support selections carry higher weight because they require trained coverage, unlike companionship-only requests. |
| How often would you like respite care coverage? | Frequency indicates whether the lead needs a single scheduling slot or represents a recurring staffing commitment. |
| Is there a current family or unpaid caregiver who needs this scheduled break? | A confirmed unpaid caregiver needing a break is the clearest signal of a genuine respite need rather than a general care inquiry. |
| Are you legally authorized to arrange care on behalf of the person receiving it? | Legal authorization to arrange care is a gating question; a 'no' answer means the assessment can't proceed until consent is confirmed. |
| Where will the respite care take place? | Segments the lead so you can route, price, and prioritize it correctly. |
How Cliont scores respite care leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Companionship and supervision only
- Personal care such as bathing or dressing
- Help with walking or transfers
- Medication reminders
- No regular support needed yet
- There Current Family Or: yes
Disqualifiers
- Not sure yet
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Respite Care 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 respite care workflows
| Cliont capability | Respite Care application |
|---|---|
| Weighted multi-select scoring | Personal care and mobility support selections carry more scoring weight than companionship-only, so leads needing hands-on assistance surface above simple supervision requests. |
| Authorization gate | The yes/no authorization question lowers a lead's score when the requester isn't legally authorized, prompting a manual check instead of an automatic care assessment booking. |
| Frequency-based routing | Frequency answers (one-time, occasional, weekly, not sure) let your team separate recurring respite schedules from single-occasion requests for different follow-up sequences. |
| Location capture | Knowing whether care happens in the person's home, the caregiver's home, or elsewhere lets staff confirm coverage area before committing to a care assessment. |
Example respite care lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Weekly break for a burnt-out caregiver
A family member handling personal care and mobility support daily requests a recurring weekly schedule, which the intake flags as a high-value, ongoing respite need.
One-time occasion, low support needs
A relative asks for a single day of companionship coverage while the older adult needs no personal care yet, which scores lower but still routes to your CRM for scheduling.
Coordinator without arranging authority
Someone identifies as a care coordinator rather than the person or family member, and the authorization question surfaces so staff can confirm consent before booking.
Undecided on how often they'll need coverage
A family selects 'not sure yet' on frequency while support needs include bathing and medication reminders, signaling a lead worth a call to scope the actual respite pattern.
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 non-medical home care intake templates
Respite Care lead-intake FAQs
How does the intake identify who the care is actually for?
The first question asks whether the respite care is for the requester themselves, a family member, or a client they coordinate care for, so your team knows immediately whether they're speaking with the decision-maker.
Can a family select more than one type of daily support?
Yes, the daily support question is multi-select, so a family can flag personal care, mobility assistance, and medication reminders together, and each selection contributes to the lead's overall score.
How do you handle requests from someone who isn't legally authorized?
The intake includes a direct yes/no question on legal authority to arrange care; a 'no' answer scores lower so staff can follow up and confirm consent or identify the right point of contact before a care assessment is booked.
Does the intake distinguish one-time coverage from a recurring schedule?
Yes, families choose between a one-time occasion, occasional as-needed coverage, a regular weekly schedule, or 'not sure yet,' which helps your team prioritize scheduling and staffing conversations differently.
Why does the intake ask whether there's a current unpaid caregiver?
That question is a core respite signal: a 'yes' indicates a real caregiver actively needing a scheduled break, while a 'no' still qualifies the lead but with a lower weight since the urgency driver is different.
Does the intake capture where the care will happen?
Families are asked whether care will take place in the person's own home, the caregiver's home, or another location, which lets your team confirm the request falls within your service area before scheduling.
Turn respite care visitors into qualified patients
Give every respite care visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.