Intake Process │ ├── 1. Initial Inquiry Log ├── 2. External Intake Form (Family Submission) ├── 3. Internal Screening Template (Fit Assessment) ├── 4. Referral Logic Matrix ├── 5. Decline Scripts & Protocols
Use a simple Notion database or table to record every inbound interest, even if it doesn’t convert.
Fields to Track: • Date of inquiry • Source (referral, word of mouth, etc.) • Family contact name & info • Aging adult name • Urgency level • Notes (brief) • Next step (e.g., send intake form, hold, decline)
Built in Fillout and auto-populates into Notion. Designed for families to complete before discovery.
Section 1: Client Overview • Name, age, pronouns • Living arrangement (alone, with spouse, facility, etc.) • Daily independence (basic vs. assisted) • Any current in-home support (e.g. paid caregivers, PT, RN)
Section 2: Family Contact • Primary family contact(s) • Relationship to client • Email + phone • POA status or legal authority (Yes/No)
Section 3: Observed Needs • Check all that apply: • Forgetting appointments • Missed medications • Safety concerns (falls, wandering) • Loneliness or depression • Home disrepair • Struggling with paperwork • Difficulty communicating with siblings • Other: _______
Section 4: Current Support Ecosystem • Other services in place (Home care? Geriatric care manager? House cleaner?) • Gaps or concerns with those providers • Financial ability: are you planning to self-pay for 6–12 months?
Section 5: Goals or Expectations • “What would success look like to you?” • “Why now?” • “What has already been tried?”
Section 6: Consent to Review & Contact • Checkbox: “I consent to Cedar & Iron reviewing this submission and contacting me to explore next steps.”
Used by you during review of intake or screening call (Notion template)
Client Snapshot • Name / Age / Living Arrangement • Tier likely required: Peace / Care / Legacy • Financial fit for at least 6 months: Yes / No / Unsure • Family dynamics (supportive / fragmented / tense)
Observed Needs • ✔️ Light support only • ⚠️ Borderline Care-tier needs • ❌ Outside scope (ADLs, dementia, etc.)
Red Flags • ☐ Unsafe home • ☐ Unrealistic expectations • ☐ Prior provider burnout • ☐ Emotional volatility • ☐ Medical needs I can’t support