---
title: Senior Care Mobility & Accessibility Equipment Purchase Request Form | Paperform
description: Professional form template for senior care facilities to request mobility and accessibility equipment with resident assessment data, Medicare/Medicaid coverage verification, and staff training needs.
url: "https://paperform.co/templates/senior-care-facility-mobility-accessibility-equipment-purchase-request"
type: static
generatedAt: "2026-03-28T00:45:09.454Z"
---

[← Back to free form templates](/templates/)    ![Senior Care Facility Mobility & Accessibility Equipment Purchase Request](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/senior-care-facility-mobility-accessibility-equipment-purchase-request.png)
    [Preview](https://_preview.paperform.co/ai-template/senior-care-facility-mobility-accessibility-equipment-purchase-request) [Use this template for free](/create?ai-template=senior-care-facility-mobility-accessibility-equipment-purchase-request)    [Request Forms](/templates/category/requests/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Senior Care](/templates/industry/senior-care/) [Nurse](/templates/role/nurse/)[Physical Therapist](/templates/role/physical-therapist/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/)[Occupational Therapist](/templates/role/occupational-therapist/)[Facilities Manager](/templates/role/facilities-manager/)     About this free form template
### Simplify Equipment Procurement for Senior Care Facilities

Managing mobility and accessibility equipment requests in senior care settings requires careful coordination between clinical assessment, budget approval, insurance verification, and staff training. This **Senior Care Facility Mobility & Accessibility Equipment Purchase Request form** brings all these critical elements together in one streamlined workflow.

#### Built for Senior Care Operations

Whether you're a care coordinator, facility administrator, or occupational therapist, this template helps you capture complete resident assessment data, justify equipment needs with clinical documentation, verify Medicare or Medicaid coverage eligibility, and identify staff training requirements—all before the purchase is approved.

The form guides requestors through essential information including resident mobility levels, fall risk assessment, current equipment inventory, and specific accommodation needs. Conditional logic ensures you only collect relevant details based on equipment type and funding source, making the process faster for staff while maintaining compliance documentation.

#### Automate Approvals and Vendor Communication

Once submitted, connect this form to **Stepper** (stepper.io) to automate your procurement workflow. Route requests to clinical directors for medical necessity review, send to finance for budget approval, notify vendors automatically, and trigger staff training scheduling—all without manual handoffs or email chains.

Paperform's payment integrations let you process deposits or full payments directly when approved, while native CRM and project management integrations keep your equipment inventory, resident records, and maintenance schedules synchronized across systems.

#### Compliance-Ready Documentation

With SOC 2 Type II compliance and robust data security, Paperform helps senior care facilities maintain the documentation standards required for insurance reimbursement and regulatory audits. Capture assessment scores, physician recommendations, and approval signatures in one secure location with full audit trails.

Trusted by healthcare and senior care organizations, this template gives your team a professional, compliant way to manage equipment requests that improve resident safety, independence, and quality of life.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Assisted Living Facility Healthcare Supplies Purchase Request](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/assisted-living-facility-healthcare-supplies-purchase-request.png)

### Assisted Living Facility Healthcare Supplies Purchase Request

A comprehensive internal purchase request form for assisted living facilities to order healthcare supplies while tracking resident census data, care plan requirements, and state inspection compliance needs.](/templates/assisted-living-facility-healthcare-supplies-purchase-request/)
[![Assisted Living Facility Maintenance Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/assisted-living-facility-maintenance-request-form.png)

### Assisted Living Facility Maintenance Request Form

A specialized maintenance request form for assisted living facilities that prioritizes resident safety, tracks care impact, and enables automated family notifications for critical issues.](/templates/assisted-living-facility-maintenance-request-form/)
[![Assisted Living Service Plan Modification Approval Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/assisted-living-service-plan-modification-approval-form.png)

### Assisted Living Service Plan Modification Approval Form

Request approval for modifications to resident service plans, including care level changes, cost adjustments, and family notifications in assisted living facilities.](/templates/assisted-living-service-plan-modification-approval-form/)
[![Home Healthcare Agency Medical Supplies Purchase Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/home-healthcare-agency-medical-supplies-purchase-request-form.png)

### Home Healthcare Agency Medical Supplies Purchase Request Form

Streamline medical supply procurement for home healthcare agencies with automated patient census tracking, insurance authorization validation, and emergency stock level monitoring.](/templates/home-healthcare-agency-medical-supplies-purchase-request-form/)
[![Home Healthcare Patient Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/home-healthcare-patient-enrollment-form.png)

### Home Healthcare Patient Enrollment Form

Comprehensive enrollment form for home healthcare services with mobility assessment, home safety evaluation, medication needs, and caregiver training requirements.](/templates/home-healthcare-patient-enrollment-form/)
[![Home Healthcare Visit Preparation Checklist](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/home-healthcare-visit-preparation-checklist.png)

### Home Healthcare Visit Preparation Checklist

A comprehensive checklist for home healthcare professionals to ensure they're fully prepared before each patient visit, covering chart review, medication verification, equipment checks, and emergency contacts.](/templates/home-healthcare-visit-preparation-checklist/)
[![Horticultural Therapy Session Booking Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/horticultural-therapy-session-booking-form.png)

### Horticultural Therapy Session Booking Form

Book horticultural therapy sessions with personalized nature connection goals, mobility assessments, and seasonal program matching for therapeutic gardening experiences.](/templates/horticultural-therapy-session-booking-form/)
[![Hospice Care Facility Lost Belongings Report](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-facility-lost-belongings-report.png)

### Hospice Care Facility Lost Belongings Report

A compassionate form for reporting lost or missing personal belongings in hospice care facilities, helping staff track items and notify families promptly.](/templates/hospice-care-facility-lost-belongings-report/)
[![Hospice Care Medical Equipment Purchase Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-medical-equipment-purchase-request-form.png)

### Hospice Care Medical Equipment Purchase Request Form

Streamline hospice equipment procurement with Medicare DME compliance tracking, patient comfort assessments, and family training coordination in one professional form.](/templates/hospice-care-medical-equipment-purchase-request-form/)
[![Senior Care Facility Supply Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/senior-care-facility-supply-request-form.png)

### Senior Care Facility Supply Request Form

A comprehensive supply request form for senior care facilities to order medical supplies, equipment, and materials with proper documentation for Medicare reimbursement and infection control compliance.](/templates/senior-care-facility-supply-request-form/)
[![Skilled Nursing Facility Therapy Visitor Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/skilled-nursing-facility-therapy-visitor-form.png)

### Skilled Nursing Facility Therapy Visitor Form

A comprehensive visitor registration form for skilled nursing facilities managing therapy session visits with HIPAA compliance, fall risk awareness, infection control protocols, and rehabilitation schedule coordination.](/templates/skilled-nursing-facility-therapy-visitor-form/)
[![Stroke Recovery Exercise Emergency Contact Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/stroke-recovery-exercise-emergency-contact-form.png)

### Stroke Recovery Exercise Emergency Contact Form

A comprehensive form for stroke recovery patients to document emergency contacts, affected areas, mobility needs, therapy coordination, and neurologist monitoring information for safe exercise programs.](/templates/stroke-recovery-exercise-emergency-contact-form/)