Know which post-op referrals are ready for an appointment
The intake asks about surgery type, time since surgery, and surgeon clearance, plus discharge paperwork, so your team knows exactly which referrals are ready to schedule and which still need clearance first.
The exact intake your post-surgical rehabilitation leads complete
This is the real 6-question guided intake for Post-Surgical Rehabilitation — the same flow your customers finish before you ever pick up the phone.
What a qualified post-surgical rehabilitation lead should tell you
Physical therapy care for patients recovering from orthopedic, spine, cardiac, thoracic, or abdominal surgery, where eligibility depends on how much time has passed since the operation and whether the surgeon has cleared the patient for therapy.
- Surgery Was Performed
- Long Ago Was Surgery
- Have Referral Or Clearance
- Current Level Mobility Or
- Would Prefer Receive Therapy
- Completing This Request
The questions your team needs answered
Every post-surgical rehabilitation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What type of surgery was performed? | Segments the lead so you can route, price, and prioritize it correctly. |
| How long ago was the surgery performed? | The catalog weights the two-to-six-week post-op window highest, so this answer alone can push a lead into the priority band. |
| Do you have a referral or clearance from your surgeon for physical therapy? | A confirmed surgeon referral or clearance removes the biggest scheduling risk, since booking an uncleared patient wastes an appointment slot. |
| What is your current level of mobility or independence? | Mobility level tells staff whether the patient needs a standard session or additional support and equipment on arrival. |
| Where would you prefer to receive therapy sessions? | Segments the lead so you can route, price, and prioritize it correctly. |
| Who is completing this request? | Knowing whether a caregiver submitted the request tells staff to confirm details with the patient directly before confirming the appointment. |
How Cliont scores post-surgical rehabilitation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 2 weeks ago
- 2 to 6 weeks ago
- 6 weeks to 6 months ago
- More than 6 months ago
- Have Referral Or Clearance: yes
See the lead your team receives
Post-Surgical 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 post-surgical rehabilitation workflows
| Cliont capability | Post-Surgical Rehabilitation application |
|---|---|
| Conditional branching | Routes leads differently based on surgery type — orthopedic, spine, cardiac, thoracic, or abdominal — so referrals reach the clinician best suited to that recovery pathway. |
| Weighted scoring engine | Applies the catalog's time-since-surgery and clearance-status weights automatically, so a two-to-six-week post-op patient with clearance ranks above a six-month-old case without documentation. |
| Document capture | Collects surgeon referral or clearance paperwork alongside the intake answers, so staff can verify eligibility before a slot is offered. |
| Caregiver-aware routing | Flags submissions where a caregiver completed the form instead of the patient, so front-desk staff know to confirm details directly with the patient before scheduling. |
Common post-surgical rehabilitation lead scenarios
Early post-op, cleared and ready
A patient is two to six weeks past a knee or shoulder surgery and already has surgeon clearance on file, landing in the highest-value window the catalog scores for.
Clearance still pending
A patient wants to start therapy but hasn't yet received surgeon sign-off, so the intake flags the missing referral instead of letting a slot get booked prematurely.
Caregiver submitting for a bed-bound patient
A family member completes the form on behalf of a patient who is mostly non-ambulatory, signaling a need for home-based sessions rather than a standard clinic visit.
Chronic case, months post-surgery
A patient had surgery over six months ago and is looking for continued rehab, which the catalog weights lower than the acute recovery windows but still routes for review.
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
Post-Surgical Rehabilitation lead-intake FAQs
Does the intake confirm surgeon clearance before a slot gets booked?
Yes. The intake asks directly whether the patient has a referral or clearance from their surgeon, and that answer carries meaningful weight in the score so unclear cases surface before scheduling.
How does time since surgery affect how a lead is prioritized?
Patients within two to six weeks post-surgery score highest, since that window typically carries the strongest clinical need for supervised rehab, while cases more than six months out score lower.
Can a caregiver or family member fill out the intake instead of the patient?
Yes, the intake includes a question asking who is completing the request, so your team knows when a caregiver is submitting on behalf of a patient who may need more hands-on support.
What happens if a patient prefers home visits instead of clinic sessions?
The intake captures preferred session location — clinic, home, telehealth, or no preference — so your staff can match the lead to the right delivery model before booking.
Does mobility level change how a lead is handled?
Mobility answers, from independent with minor limitations to mostly bed-bound, help your team anticipate equipment or staffing needs and are a factor separate from the timing and clearance score.
Is this the right intake for joint replacement or work injury patients too?
This intake is built specifically for post-surgical recovery; if a lead is recovering from a work-related injury or general joint issue without surgery, the work injury rehabilitation or joint rehabilitation intakes are a better fit.
Turn post-surgical rehabilitation visitors into qualified patients
Give every post-surgical rehabilitation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.