See mobility needs and trip frequency before you assess the family
Every submission captures the reason for travel, mobility assistance level, and how often transportation is needed, plus a photo of any mobility aid, so you know before the care assessment whether you can staff the trip.
The exact intake your transportation assistance leads complete
This is the real 5-question guided intake for Transportation Assistance — the same flow your customers finish before you ever pick up the phone.
What a qualified transportation assistance lead should tell you
Non-medical transportation support that gets an older adult to appointments, errands, or outings, scoped by mobility assistance level, frequency of need, and destination area so a provider can confirm they can safely staff the trip.
- Main Reason Transportation Help
- Level Mobility Assistance Needed
- Often Transportation Assistance Needed
- Authorized Arrange This Care
- In What General Area
The questions your team needs answered
Every transportation assistance intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason transportation help is needed? | Medical-appointment transport usually implies recurring, time-sensitive trips, while errands or social outings tend to be more flexible in scheduling. |
| What level of mobility assistance is needed during transport? | The mobility assistance level determines whether a standard vehicle and driver will work or whether a wheelchair-accessible vehicle must be arranged in advance. |
| How often is transportation assistance needed? | Frequency separates one-off requests from daily or near-daily needs, which changes how you prioritize staffing and driver assignment. |
| Are you authorized to arrange this care on behalf of the person needing it? | Confirming authorization up front avoids scheduling an assessment based on a request from someone who can't actually commit the family to care. |
| In what general area is transportation needed? | The general area tells you whether the trip falls inside your service radius before you spend time on a callback. |
How Cliont scores transportation assistance leads
Every answer is weighted automatically — no manual review required.
Value signals
- No assistance needed
- Help getting in and out of vehicle
- Wheelchair-accessible vehicle needed
- Not sure
- Daily
- A few times a week
See the lead your team receives
Transportation Assistance 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 transportation assistance workflows
| Cliont capability | Transportation Assistance application |
|---|---|
| Guided qualification form | Walks the family through reason for travel, mobility assistance level, and frequency in sequence so you see vehicle and scheduling requirements before calling back. |
| Lead scoring engine | Weights daily and a few-times-a-week frequency alongside wheelchair-accessible or hands-on mobility needs higher, surfacing recurring, higher-effort transport requests first. |
| CRM routing | Sends qualified transportation requests to your CRM tagged with mobility level and frequency, so dispatch can match the right vehicle and driver availability. |
| Authorization check | Uses the authorized-to-arrange question to flag inquiries submitted by someone other than the decision-maker before you invest assessment time. |
Common transportation assistance lead scenarios
Daily dialysis or medical transport
A family needs help getting to recurring medical appointments and selects daily frequency with a wheelchair-accessible vehicle requirement, both flagged as high-value signals worth prioritizing for a care assessment.
One-time errand run
Someone requests a single trip for shopping or errands with no ongoing mobility assistance needed, giving you a lower-commitment lead you can still schedule but shouldn't route with the same urgency as recurring cases.
Adult child arranging for a parent
The person filling out the form confirms they're authorized to arrange care but marks mobility assistance as 'not sure,' signaling you'll need a follow-up call to clarify the vehicle type before the assessment.
Weekly social outings request
A family wants a few times a week transport for social or recreational outings rather than medical visits, a different reason code that changes how you staff and schedule versus appointment-driven trips.
Unauthorized inquiry
The submitter answers no to being authorized to arrange care on behalf of the person needing transport, a lower-confidence lead you'll want to verify before committing assessment time.
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 non-medical home care intake templates
Transportation Assistance lead-intake FAQs
Does the intake tell me if a wheelchair-accessible vehicle is required?
Yes. The mobility assistance question captures whether no help, help getting in and out, or a wheelchair-accessible vehicle is needed, so you can confirm vehicle compatibility before scheduling an assessment.
Can I tell recurring transport needs apart from one-time requests?
The frequency question separates daily, a few times a week, occasional, and one-time needs, which lets you prioritize recurring transport relationships over single trips.
What happens if the person submitting the form isn't authorized to arrange care?
The authorization question flags this directly, so you can see whether you're speaking with the decision-maker or need to loop in the actual family member before booking an assessment.
Does the intake capture where the transportation is needed?
Yes, a free-text area field lets the family describe the general location, which helps you confirm the request falls inside your service area before you commit staff time.
How does the intake distinguish medical trips from errands or social outings?
The reason-for-transport question separates medical appointments, errands, social outings, and work or volunteer commitments, so you can route medical-appointment leads differently than one-off errand requests.
How is a lead scored when the family isn't sure about mobility needs?
A 'not sure' mobility answer still carries meaningful weight in scoring, since it usually signals a real transport need, but it's flagged for a clarifying call rather than an automatic vehicle assignment.
Turn transportation assistance visitors into qualified patients
Give every transportation assistance visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.