Every physical therapy enquiry, scored before it reaches your CRM
Ask about the reason for therapy, current mobility, and referral status upfront, then collect any prescription documents so your team can see who's ready to schedule a home visit and who needs a referral first.
The exact intake your physical therapy at home leads complete
This is the real 7-question guided intake for Physical Therapy at Home — the same flow your customers finish before you ever pick up the phone.
What a qualified physical therapy at home lead should tell you
In-home visits from a physical therapist to rebuild strength, mobility, and balance after surgery, a fall, or a worsening chronic condition — the intake needs to know why therapy is needed, how the person currently moves, and whether a referral already exists.
- Main Reason Physical Therapy
- Person Have Doctor'S Referral
- Person Move Around Home
- Will Be Present Assist
- Soon Physical Therapy Sessions
- Person Able Safely Get
- City Or Area Home
The questions your team needs answered
Every physical therapy at home intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason physical therapy is needed? | The stated reason for therapy separates acute, high-need cases like surgery recovery or a fall from lower-urgency general wellness requests. |
| Does the person have a doctor's referral or prescription for physical therapy? | A confirmed referral signals the therapy is medically indicated and ready to schedule, while a 'no' flags a follow-up to secure documentation first. |
| How does the person currently move around the home? | Current mobility level tells the therapist what equipment and safety precautions to bring to the first visit. |
| Who will be present to assist during the therapy sessions? | Knowing who will be present during sessions helps staff plan whether a caregiver needs to be scheduled to assist. |
| How soon do you need physical therapy sessions to begin? | How soon the family wants to start distinguishes active recovery cases from families still comparing providers. |
| Is the person able to safely get in and out of bed or a chair without falling? | Whether the person can safely transfer in and out of bed or a chair flags fall risk before the first home visit. |
| What city or area is the home located in? | Captures the detail in the patient’s own words so you’re briefed before the first call. |
How Cliont scores physical therapy at home leads
Every answer is weighted automatically — no manual review required.
Value signals
- Recovery after surgery
- Fall or injury
- Chronic condition management
- General strength and balance improvement
- Not sure
- Person Have Doctor'S Referral: yes
Urgency signals
- Immediately
See the lead your team receives
Physical 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 physical therapy at home workflows
| Cliont capability | Physical Therapy At Home application |
|---|---|
| Automatic lead scoring | Weighs surgery recovery and fall/injury reasons above general wellness enquiries so higher-need families surface first in your queue. |
| Guided intake logic | Moves from the reason-for-therapy and referral questions straight into mobility and assistance questions so families aren't asked anything redundant. |
| CRM routing | Sends the completed intake, including mobility level and who will assist during sessions, directly into your CRM so scheduling can happen without re-asking the family. |
| Location capture | Logs the free-text city or area field so office staff can confirm the home falls within your coverage area before committing a therapist's time. |
Common physical therapy at home lead scenarios
Post-surgery recovery, ready now
A family reports recovery after surgery, already has a referral, and wants sessions to start immediately — the intake flags this as a high-priority, schedule-ready lead.
Fall injury, no referral yet
A senior recently fell and is mostly bed-bound, but the family hasn't secured a doctor's referral — the intake still captures the enquiry but routes it for a follow-up on the referral before booking.
Chronic condition, steady timeline
A family managing an ongoing condition like Parkinson's has a paid aide available and only needs sessions to start within the month — a real need, but with less urgency than acute recovery cases.
General wellness, just exploring
A family asks about strength and balance work with no referral and no firm timeline — the intake captures it for nurture rather than immediate scheduling, since both the reason and referral answers carry lower weight.
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 home health care intake templates
Physical Therapy at Home lead-intake FAQs
Does a family need a doctor's referral before the intake will let them submit?
No. The referral question is a yes/no field that affects scoring, not a gate — a confirmed referral raises the lead's priority, while a 'no' answer still comes through but flags that your team may need to follow up on paperwork before scheduling.
How does the intake account for a senior who's bedbound versus one who's walking with a cane?
The mobility question captures whether the person walks independently, uses a cane or walker, uses a wheelchair, or stays mostly in bed, so your staff know what equipment or transfer assistance to plan for before the first assessment.
What happens if a family says they're 'just exploring options'?
That timeline answer carries the lowest weight of the options on that question, so the lead still lands in your CRM but is distinguishable from families who want sessions to start immediately or within the week.
Can the intake tell me who will be around during the sessions?
Yes — it asks whether a family caregiver, a paid aide, or no one will be present, which helps your team confirm whether a caregiver needs to be coordinated ahead of the first visit.
How is this different from the Occupational Therapy at Home intake?
This intake is built around therapy reason, referral status, and physical mobility, since PT here focuses on strength, balance, and movement recovery rather than the daily-living-task focus of the Occupational Therapy at Home form.
Turn physical therapy at home visitors into qualified patients
Give every physical 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.