Know which neurologic rehab leads are appointment-ready
Patients share their neurological condition, current functional difficulties, and whether a doctor has already recommended therapy — and upload their physician referral — so your team knows who's ready for an appointment before anyone books a slot.
The exact intake your neurologic rehabilitation leads complete
This is the real 6-question guided intake for Neurologic Rehabilitation — the same flow your customers finish before you ever pick up the phone.
What a qualified neurologic rehabilitation lead should tell you
Physical therapy focused on movement, balance, coordination, or strength deficits caused by a neurological condition such as stroke, spinal cord injury, TBI, Parkinson's, or MS — where the intake needs to confirm diagnosis, physician involvement, and functional impact before scheduling.
- Underlying Neurological Condition Related
- Doctor Recommended Physical Therapy
- Main Functional Difficulty Right
- This Therapy Request
- Therapy Expected Take Place
- Soon Would Like Therapy
The questions your team needs answered
Every neurologic rehabilitation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the underlying neurological condition related to this therapy need? | The specific diagnosis determines which therapists and protocols apply, letting staff route the lead to the right clinician before the first appointment. |
| Has a doctor recommended physical therapy for this condition? | A confirmed physician recommendation is weighted higher than a no-answer, signaling medical necessity versus a lead that may need a referral first. |
| What is the main functional difficulty right now? | Each selected functional limitation adds its own weight, so patients reporting multiple deficits score higher than single-issue or no-difficulty cases. |
| Who is this therapy request for? | Knowing whether the patient, a family member, or a professional caregiver is submitting determines who staff should contact and what consent is needed. |
| Where is the therapy expected to take place? | Whether care happens outpatient, at home, or inpatient determines which calendar and staffing resources the lead should be routed to. |
| How soon would you like therapy to begin? | The desired start timeline separates leads needing immediate scheduling from those still exploring options. |
How Cliont scores neurologic rehabilitation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Doctor Recommended Physical Therapy: yes
- Walking or balance
- Arm or hand use
- Speech or swallowing
- General weakness or fatigue
- Coordination or fine motor control
Urgency signals
- Immediately
See the lead your team receives
Neurologic Rehabilitation 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 neurologic rehabilitation workflows
| Cliont capability | Neurologic Rehabilitation application |
|---|---|
| Weighted lead scoring | Stacks points for functional difficulties like walking/balance and arm/hand use, and boosts leads where a doctor has already recommended therapy, so complex neuro cases surface above general inquiries. |
| Document upload | Collects the physician referral or therapy order at intake so front-desk staff can confirm medical necessity before assigning a treatment slot. |
| Requester routing | Flags whether the submission comes from the patient, a family member, or a professional caregiver, so staff know who to call and what consent to request. |
| Care-setting logic | Separates outpatient clinic requests from home-visit and inpatient facility requests so scheduling teams route each lead to the right calendar. |
Common neurologic rehabilitation lead scenarios
Post-stroke patient with physician referral
Stroke selected, doctor recommendation confirmed, and walking/balance plus arm/hand difficulty both flagged — the intake pushes this lead to the top with all the context staff need to schedule immediately.
Family member inquiring for Parkinson's care
The requester answers as a family member rather than the patient, condition is Parkinson's, and no doctor referral exists yet — the intake still captures the lead but flags the missing referral for staff to address before booking.
Professional caregiver requesting home visits
A caregiver selects 'a patient I care for professionally,' chooses home visits as the setting, and reports coordination or fine motor difficulty — routing this to a home-visit calendar instead of an outpatient clinic slot.
Patient still exploring, no referral yet
Condition marked 'Not sure,' no doctor recommendation, and timeline set to 'Just exploring options' — the intake scores this lower so staff can follow up with education rather than an appointment offer.
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 physical therapy intake templates
Neurologic Rehabilitation lead-intake FAQs
Can the intake tell whether the patient or a caregiver is submitting the request?
Yes. One question asks whether the request is for the patient themselves, a family member, or a patient the requester cares for professionally, so staff know who to contact and what consent may be needed.
What happens if a patient hasn't been referred by a doctor yet?
A confirmed physician recommendation is weighted higher than a 'no' answer, so unreferred patients still come through but score lower, letting staff decide whether to request a referral before scheduling.
Does the intake capture which neurological condition the patient has?
Yes, patients select from stroke, spinal cord injury, TBI, Parkinson's, MS, another condition, or 'not sure,' so your team has diagnosis context before the first call.
How does the form handle patients with more than one functional limitation?
The functional difficulty question allows multiple selections — walking/balance, arm/hand use, speech/swallowing, weakness, or coordination — and each selection adds weight, so multi-symptom patients score higher than single-issue inquiries.
Can leads be separated by whether they need outpatient, home, or inpatient care?
Yes, the intake asks where therapy is expected to take place, so outpatient clinic requests can be routed differently from home-visit or inpatient rehab facility requests.
What if someone is just exploring options and isn't ready to book?
The timeline question includes a 'just exploring options' answer, which carries less weight than 'immediately,' so these leads land in your CRM as lower-priority follow-ups rather than appointment requests.
Turn neurologic rehabilitation visitors into qualified patients
Give every neurologic rehabilitation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.