I had a client who completed an implementation meeting but was not very effusive about the benefits of our work together so far. She is an elderly lady who is very passive and doesn't seem to have many friends she hangs out with. She sticks with mostly family who are all broke.

Maybe. But, as a rule, I don't buy it. If you want to let them off the hook and blow off the referral process, that's your prerogative. If you do, my prediction is that it will become one of many reasons why you let different clients choose whether or not they participate for different reasons. My advice: all in.