Mobility equipment intake that captures clinician recommendations up
Families tell you upfront which equipment type they need, whether a doctor or therapist already recommended something specific, and whether the need is immediate or for future planning. Photos of the home setup and any clinical referral come in with every submission, so your team knows who's ready for a care assessment.
The exact intake your mobility equipment consultation leads complete
This is the real 6-question guided intake for Mobility Equipment Consultation — the same flow your customers finish before you ever pick up the phone.
What a qualified mobility equipment consultation lead should tell you
A consultation that helps a family or care coordinator identify the right mobility aid — cane, walker, wheelchair, scooter, or transfer aid — based on how it will be used, where, and whether a clinician has already weighed in.
- Mobility Equipment Interested In
- Equipment Primarily
- Will Equipment Mainly Be
- Doctor Or Therapist Recommended
- Equipment Needed Immediate Daily
- Person Who Will Make
The questions your team needs answered
Every mobility equipment consultation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Which type of mobility equipment are you interested in? | The specific equipment type requested (wheelchair, scooter, lift chair, etc.) tells your team what expertise and inventory the assessment needs to cover. |
| Who is the equipment primarily for? | Knowing whether the submitter is the end user, a family member, or a professional care coordinator determines who needs to be present at the assessment and how to communicate. |
| Where will the equipment mainly be used? | Segments the lead so you can route, price, and prioritize it correctly. |
| Has a doctor or therapist recommended a specific type of equipment? | A clinician recommendation means the equipment need is medically grounded, which typically shortens the consultation and raises the likelihood of a fast decision. |
| Is the equipment needed for immediate daily use or for future planning? | Immediate daily need signals a lead ready to book now, while future-planning-only responses indicate a longer nurture timeline before an assessment makes sense. |
| Are you the person who will make the final decision on equipment purchase? | Confirming the submitter is the final decision-maker avoids scheduling an assessment that stalls because another family member still needs to weigh in. |
How Cliont scores mobility equipment consultation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Cane or walker
- Wheelchair
- Mobility scooter
- Lift chair or transfer aid
- Not sure
- Doctor Or Therapist Recommended: yes
Urgency signals
- Immediate daily use
See the lead your team receives
Mobility Equipment Consultation 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 mobility equipment consultation workflows
| Cliont capability | Mobility Equipment Consultation application |
|---|---|
| Conditional branching | The intake can adjust follow-up questions based on which equipment type is selected, since a wheelchair inquiry and a lift chair inquiry need different context. |
| Weighted lead scoring | A doctor or therapist recommendation and an immediate-use timeline both push the score up, so leads ready for a care assessment now surface ahead of future-planning inquiries. |
| Role-based lead segmentation | Separates leads where the submitter is the equipment user, a family member, or a professional care coordinator, so coordinator referrals can be tracked differently from direct family inquiries. |
| Document capture | Collects a clinician referral or prescription alongside the intake when one exists, so your team has it in hand before the assessment instead of chasing it down afterward. |
Common mobility equipment consultation lead scenarios
Doctor-recommended wheelchair, immediate need
A family reports a clinician-recommended wheelchair needed for daily use starting now, with the family member as the decision-maker — this combination scores toward the top of the queue.
Care coordinator planning for a client
A professional coordinator submits on behalf of a client, marks the need as future planning only, and isn't sure which equipment type fits — the intake still qualifies the lead but flags it as an earlier-stage inquiry.
Family researching without a referral
An adult child inquires for an aging parent with no clinician recommendation yet and isn't the final purchase decision-maker, signaling a lead that needs more information before an assessment is scheduled.
Facility resident needs a transfer aid
Equipment is needed for a resident in a care facility rather than a private home, changing the delivery, fitting, and installation logistics your team needs to plan for before the visit.
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 senior mobility and safety intake templates
Mobility Equipment Consultation lead-intake FAQs
How does the intake flag a lead when a doctor has already recommended specific equipment?
The intake asks directly whether a doctor or therapist has recommended a specific type of equipment, and that answer carries meaningfully more weight than a family exploring options on their own.
Can I tell the difference between someone who needs equipment now versus someone just planning ahead?
Yes — the intake separates immediate daily use, anticipated need soon, and future planning only, so you can prioritize the assessments that need to happen this week over those that don't.
Does the intake tell me who actually makes the purchase decision?
It asks whether the person submitting the form is the one who will make the final decision on the equipment purchase, so you're not scheduling an assessment with someone who needs to loop in a spouse or adult child first.
How does the intake handle care coordinators submitting on behalf of clients, not families directly?
The intake distinguishes whether the equipment is for the submitter, a family member, or a client they coordinate care for, so professional referrals can be routed and followed up differently than direct family inquiries.
What happens if a family isn't sure what type of equipment they even need?
Not sure is a valid answer on the equipment-type question, and it still routes to your CRM as a qualified lead — it just tells your team the assessment should start with education, not a specific product fit.
Does this overlap with your Home Safety Assessment or Fall Risk Assessment intakes?
This intake is scoped specifically to equipment selection, but it does capture where the equipment will be used — at home, in a facility, outdoors, or across multiple settings — which is useful context if the same family also needs a Home Safety Assessment or Fall Risk Assessment.
Turn mobility equipment consultation visitors into qualified patients
Give every mobility equipment consultation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.