Wheelchair Rental Client Intake Form

Finding the right mobility equipment shouldn't be complicated. This wheelchair rental intake form streamlines the entire rental process—from assessing mobility needs to selecting accessories and handling payments—all in one smooth, professional experience.

Built for medical equipment rental businesses, home healthcare providers, and mobility aid suppliers, this template helps you capture essential client information, understand specific mobility requirements, and process rental agreements efficiently. Whether you're serving short-term recovery patients, long-term care clients, or event accessibility needs, this form ensures you have all the details needed to provide the right equipment.

The form guides clients through selecting wheelchair types (manual, transport, or electric), identifying required accessories like cushions and trays, and choosing rental durations. Integrated payment processing through Paperform means you can collect deposits or full payments directly within the form—no separate invoicing needed.

Using Paperform's conditional logic, the form adapts based on client needs: selecting a power wheelchair reveals battery and charging questions, while insurance coverage triggers document upload fields. This smart branching keeps the experience relevant and avoids overwhelming clients with unnecessary questions.

Connect this form to your CRM or Google Sheets to automatically log new rentals, sync with your inventory management system, or trigger automated confirmation emails with pickup details. For businesses managing multiple rental locations or delivery schedules, you can use Stepper to automate routing workflows—assigning deliveries to the right team member, scheduling equipment prep, and sending rental agreement reminders.

Need clients to sign rental terms? Use Papersign to convert form submissions into legally binding rental agreements with eSignature capability, keeping everything connected in one seamless flow. This is perfect for capturing liability waivers, equipment condition acknowledgments, and return policies with audit trails.

With Paperform's professional design options, your rental form can match your brand and provide a welcoming, accessible experience that builds trust from the first interaction. Mobile-friendly and easy to embed on your website or share via link, this template helps mobility equipment businesses deliver better service while reducing administrative overhead.