Client Intake Form


📂 Client Intake Form Template

System for vetting and qualifying prospects to determine if they are an “ideal” client for your senior care business.

This template is perfect for:

⭐ Home Care / Home Health Agencies
⭐ Private / Independent caregivers

How can these client intake form help?

⭐ Focused marketing
⭐ Determine client’s pain points
⭐ Filter potential clients quickly
⭐ Quick access to information on file
⭐ Administrative uniformity
⭐ Form repetition saves time
⭐ Assessment dated & documented
⭐ Avoid liability issues
⭐ Know what will provide value to client
⭐ Make informed decisions

Main Features:

✔️ Reusable (master files- msWORD)
✔️ Easy to edit forms
✔️ Manually fill in

✔️ Fill form digitally
✔️ Fill form manually

✔️ Print to PDF
✔️ Send electronically

✔️ Printable 🖨️

📥 Download and use immediately!

See more product details below…


Download and customize this client intake form to your own business

Time is precious when you are overseeing all operations of your senior care business. Spend your valuable time laser focused on vetting and qualifying prospects to determine if they align with your ideal client profile.

Client Intake Form-preview of template-wise caregiving Client Intake Form-Senior Care-full preview of template-wise caregiving

Template also available in ‘How to Start a Senior Care Business’:

How to start a senior care (5)

Do you currently operate a senior care business? 

The template pack may be the perfect solution:

senior care business templates-professional forms-320x320-wisecaregiving (1)

✔️ Client intake form
✔️ Senior information / Assessment form

✔️ Fall risk assessment form
✔️ Senior care service quote
✔️ Caregiver job description form
✔️ Terms of senior care service agreement
✔️ Daily caregiver journal
✔️ Housekeeping Checklist
✔️ Personal hygiene chart
✔️ Senior care invoice
✔️ Hire a caregiver checklist
✔️ Caregiver employment application form
✔️ Pre-interview questionnaire
✔️ Caregiver interview questionnaire
✔️ Reference check questionnaire
✔️ Caregiver employment agreement
✔️ Caregiver employment contract
✔️ Caregiver job posting sample
✔️Tax receipt for senior care services
✔️ COVID-19 Screening caregiver form
✔️ Senior Transport Service Agreement
✔️ Competitor Questionnaire
✔️ Bookkeeping Checklist
✔️Home Safety Checklist

Are you ready to get organized and never miss an opportunity to make or save money? Of course not! Then let’s get started!