Know which aging-in-place enquiries deserve a care assessment
Cliont's aging-in-place intake asks about living situation, specific hazard areas like stairs and bathrooms, and any recent fall before requesting home photos — so you see exactly what a family needs before you schedule a care assessment.
The exact intake your aging-in-place planning leads complete
This is the real 7-question guided intake for Aging-in-Place Planning — the same flow your customers finish before you ever pick up the phone.
What a qualified aging-in-place planning lead should tell you
A structured evaluation of a person's living situation, home layout, and recent mobility history used to plan the modifications and safety strategies that let them keep living independently at home.
- This Primarily
- Current Living Situation Person
- Areas Concern Apply Home
- Person Had Recent Fall
- Have Authority Make Decisions
- Soon Begin Changes
- Professional Home Safety Assessment
The questions your team needs answered
Every aging-in-place planning intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this planning primarily for? | Knowing whether the submitter is planning for themselves, a family member, or a coordinated client determines who you should actually be speaking with. |
| What is the current living situation of the person? | Living alone carries the highest weight because it signals the least existing daily support and the greatest safety risk. |
| Which areas of concern apply to the home? | Stairs and bathroom concerns are weighted above general layout or 'not sure yet' because they are the areas most linked to serious falls. |
| Has the person had a recent fall or mobility change? | A recent fall or mobility change is weighted heavily since it often turns a planning conversation into a near-term safety need. |
| Do you have authority to make decisions about home modifications? | Whether the person filling out the form can actually authorize modifications determines if the lead is ready to schedule or needs another decision-maker looped in first. |
| How soon are you hoping to begin planning changes? | The stated timeline separates families ready to schedule an assessment now from those still gathering information. |
| Has a professional home safety assessment been done before? | Separates real opportunities from leads that aren’t a fit yet. |
How Cliont scores aging-in-place planning leads
Every answer is weighted automatically — no manual review required.
Value signals
- Living alone
- Living with family
- Living with a paid caregiver
- Currently considering a move
- Stairs or entry access
- Bathroom safety
Urgency signals
- Immediately
Disqualifiers
- Not sure yet
See the lead your team receives
Aging-in-Place Planning 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 aging-in-place planning workflows
| Cliont capability | Aging-In-Place Planning application |
|---|---|
| Weighted lead scoring | Living alone and a recent fall both carry higher weights than living with family or a paid caregiver, so the most at-risk households rise to the top of your queue automatically. |
| Photo upload widget | Families can attach photos of stairs, entryways, and bathrooms before the assessment, so you arrive already knowing which areas of concern were flagged. |
| Conditional routing on decision authority | Leads where the submitter lacks authority to approve modifications can be routed into a follow-up track instead of directly onto your assessment calendar. |
| Timeline-based prioritization | Answers to the planning-timeline question let you separate 'immediately' leads for near-term scheduling from 'just exploring' leads for a longer nurture sequence. |
Common aging-in-place planning lead scenarios
Living alone after a fall
Living situation is set to living alone, a recent fall is confirmed, and the timeline is immediate — the combination that should reach a care assessment first.
Adult child without authority yet
A family member submits the form but doesn't yet have decision authority over modifications, signaling the lead needs a conversation with other decision-makers before scheduling.
Care coordinator referral
A professional coordinator fills out the intake on behalf of a client who already had a prior home safety assessment, so the enquiry needs context rather than a first-time evaluation.
Just exploring options
Areas of concern are marked 'not sure yet' and the timeline is exploratory, meaning the lead can be nurtured rather than booked immediately.
Weighing a move versus staying
The living situation answer shows the family is currently considering a move, which changes the conversation from home modification to a broader independence decision.
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 senior mobility and safety intake templates
Aging-in-Place Planning lead-intake FAQs
How is this different from a Home Safety Assessment intake?
This intake starts broader — capturing living situation, who has decision authority, and general timeline — before narrowing into specific hazard areas, so it works well as the first touchpoint that can later route into a dedicated Home Safety Assessment or Fall Risk Assessment.
What happens if the person submitting the form can't approve modifications?
The decision-authority question flags this, and a 'no' answer carries lower weight than a 'yes', so those leads can be routed for follow-up conversation rather than treated as assessment-ready.
Can the intake tell me if there's already been a fall?
Yes — the recent fall or mobility change question is a direct yes/no field, and a 'yes' answer is weighted higher so those families surface as more urgent.
How do you handle leads who say they're 'just exploring'?
The planning-timeline question captures this directly, letting you still gather the full picture — living situation, hazard areas, fall history — while deprioritizing scheduling until they're ready.
Does the form work if a care coordinator submits it instead of the family?
Yes, the intake asks who the planning is for, including an option for someone coordinating care on a client's behalf, so you know the context before reaching out.
Does this intake also cover mobility equipment needs?
No — this intake focuses on the living situation and home environment; equipment-specific questions belong to the separate Mobility Equipment Consultation intake.
Turn aging-in-place planning visitors into qualified patients
Give every aging-in-place planning visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.