Home Care Client Intake Form — shared by the community

Who this template is for

Home Care Client Intake Form is built for teams with a niche process that generic forms don't cover who need to capture reproducible detail on first contact.

• Teams with a niche process that generic forms don't cover working in healthcare, legal & specialized.
• Teams who need to capture reproducible detail on first contact without writing code or paying for a custom build.
• Anyone replacing requests that need three replies before work can start with one structured record per enquiry.
• Respondents are the specific group this workflow serves — the form asks them 20 questions across 4 screens.

Why this form is useful

It removes the cost of requests that need three replies before work can start and turns each submission into a record your team can act on immediately.

• 8 questions are required, so submissions arrive complete instead of needing a follow-up email.
• It captures a phone number for urgent follow-up.
• It pins the request to a specific date.
• It captures a full postal address.
• It allows multiple selections without free text.
• Conditional logic hides 5 questions until they are relevant — shorter forms convert better than long ones.
• Splitting the form across 4 pages keeps each screen short and shows respondents how much is left.
• Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1. 1Press “Use this template” — a fresh copy of Home Care Client Intake Form lands in your workspace, ready to edit.
2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 5 conditional rules ship with it.

• Features advanced show logic: if “Mobility level” is Wheelchair-dependent or Bedbound, the form dynamically exposes “Equipment currently used (hoist, wheelchair, hospital bed, etc.)”. Otherwise that question never appears.
• Features advanced show logic: if “Mobility level” is Wheelchair-dependent or Bedbound, the form dynamically exposes “Does the client need assistance transferring in and out of bed?”. Otherwise that question never appears.
• Features advanced show logic: if “Medication management” is Needs reminders or Needs full administration support, the form dynamically exposes “Current medication list”. Otherwise that question never appears.
• Features advanced show logic: if “Medication management” is Needs reminders or Needs full administration support, the form dynamically exposes “Pharmacy name and phone number”. Otherwise that question never appears.
• Features conditional validation: if “Does the client live alone?” is Yes, “Emergency contact (not living with client)” becomes mandatory before the form can be sent.
• All 5 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.