Collect home therapy context before provider review
Give your intake team the requester’s account of why home occupational therapy is being sought, whether it was recommended, and which daily activities are difficult. Living situation, requested timing, and the requester’s role accompany those answers for provider review.
Preview your occupational therapy at home intake
Explore 6 questions from the Occupational Therapy at Home template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified occupational therapy at home lead should tell you
Intake for providers reviewing requests for occupational therapy delivered at home. The template collects the requester’s stated reason, referral context, difficult daily activities, living setting, requested timing, and contact role for clinical team review.
- Main Reason Occupational Therapy
- Doctor Or Hospital Recommended
- Daily Activities Most Difficult
- Person Needing Therapy Live
- Soon Occupational Therapy Needed
- Requesting This Service On
The questions your team needs answered
Every occupational therapy at home intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason occupational therapy is needed? | Records the requester’s stated reason without diagnosing a condition or determining care suitability. |
| Has a doctor or hospital recommended occupational therapy? | Captures a reported recommendation for the provider to verify during review. |
| Which daily activities are the most difficult right now? | Preserves the daily activities the requester identifies as difficult for clinical discussion. |
| Where does the person needing therapy currently live? | Identifies the reported living setting for staff to understand the inquiry. |
| How soon is occupational therapy needed to begin? | Records requested start timing without determining medical urgency or service availability. |
| Who is requesting this service on behalf of the person? | Identifies who is requesting the service so staff can clarify the contact relationship. |
How Cliont scores occupational therapy at home leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Recovery after hospital stay or surgery
- Gradual decline in daily living skills
- Recent fall or injury
- Managing a chronic health condition
- Other reason
- Doctor Or Hospital Recommended: yes
Urgency signals
- Immediately
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Occupational Therapy at Home 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 occupational therapy at home workflows
| Cliont capability | Occupational Therapy At Home application |
|---|---|
| Guided intake | Records the requester’s stated reason without diagnosing a condition or determining care suitability. Captures a reported recommendation for the provider to verify during review. |
| Configured scoring | The stated reason, reported recommendation, selected daily-activity concerns, and requested start window have configured weights. These support intake follow-up and do not predict treatment outcomes or establish clinical urgency. |
| Structured lead context | Records requested start timing without determining medical urgency or service availability. Identifies who is requesting the service so staff can clarify the contact relationship. |
| Team review | Yes. Living-situation choices include the person’s own home, a family member’s home, an assisted-living community, and other. |
Example occupational therapy at home lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Home inquiry following a hospital stay
A family caregiver selects recovery after a hospital stay, reports a recommendation, and identifies dressing or transfer difficulties. The provider receives that stated context before assessing the appropriate next step.
Gradual changes in daily activities
The person requesting support selects a gradual decline and household-task concerns, with a start desired within a month. Staff receive those answers for review without the software making a clinical judgment.
Care coordinator arranging a discussion
A coordinator selects an assisted-living setting and immediate requested timing. The inquiry identifies the contact role, activity concerns, and referral context so the provider can clarify the request.
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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
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Only pay when you receive a qualified lead.
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- 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 home health care intake templates
Occupational Therapy at Home lead-intake FAQs
Does the intake determine whether occupational therapy is appropriate?
No. It records the requester’s account for the provider to review. The clinical team determines assessment and service suitability; an intake score does not diagnose a condition or prescribe care.
Can a family caregiver or care coordinator submit an inquiry?
Yes. Requester-role choices include the person themselves, a family caregiver, a professional care coordinator, and other. The provider receives that role and confirms the appropriate communication arrangements.
What contributes to the initial prioritization score?
The stated reason, reported recommendation, selected daily-activity concerns, and requested start window have configured weights. These support intake follow-up and do not predict treatment outcomes or establish clinical urgency.
Can the form capture different home or community living settings?
Yes. Living-situation choices include the person’s own home, a family member’s home, an assisted-living community, and other. Staff receive that setting with the stated needs for review.
Turn occupational therapy at home visitors into qualified patients
Give every occupational therapy at home visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.