Client Intake Form (Core) - Medical Equipment Rental

🥷 Medical Equipment Rental Client Intake Form

Residential, Commercial & Facility Edition
Professional Client Onboarding & Pre-Rental Worksheet
PDF + Editable Word Download

Start every medical equipment rental with clarity, accuracy, and Ninja-level professionalism. ⚔️

This Medical Equipment Rental Client Intake Form is a streamlined onboarding document built specifically for durable medical equipment (DME providers), home healthcare suppliers, mobility rental companies, and medical equipment vendors.

It helps you collect all critical client, patient, facility, equipment, delivery, and billing details before quoting, scheduling, or delivering equipment — ensuring smooth setups, accurate rentals, and fewer costly mistakes.

Whether you rent hospital beds, oxygen equipment, wheelchairs, lifts, scooters, or respiratory devices, this intake form ensures you gather the right information upfront so every delivery runs like a well-trained Ninja operation.

If you want smoother bookings, cleaner estimates, and more professional workflows — this intake form belongs at the front of your operation.

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⚔️ What This Medical Equipment Rental Intake Form Helps You Do

This ready-to-use form allows you to:

✔ Capture complete client and patient information
✔ Document responsible party or facility details
✔ Record emergency contact information
✔ Track requested equipment and accessories
✔ Confirm rental duration and delivery preferences
✔ Identify medical and mobility needs
✔ Flag access limitations and delivery challenges
✔ Capture billing and payment preferences
✔ Reduce back-and-forth communication
✔ Secure client authorization before delivery

Everything is structured so you can quote accurately, deliver efficiently, and support patients safely.

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🧰 What’s Included (PDF + Editable Word)

✔ Fill-Ready PDF
Perfect for email intake, tablets, mobile use, or printed onboarding packets.

✔ Fully Editable Word Document (.docx)
Customize fields, equipment categories, wording, or branding to match your exact rental workflow.

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🥷 Built-In Ninja Precision

This professionally formatted intake form includes:

👤 Client & Patient Information

Tracks:
• Client / patient name
• Date of birth
• Phone & email
• Service address
• Emergency contact & relationship

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🏥 Responsible Party / Facility Section

Documents:
• Facility or responsible party name
• Relationship to client
• Contact details
• Billing address

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🩺 Equipment & Accessories Selection

Checkboxes for common DME rentals including:
• Hospital beds (standard & motorized)
• Mattresses & bed rails
• Patient lifts & Hoyer lifts
• Lift chairs
• Manual & transport wheelchairs
• Mobility scooters
• Walkers & crutches
• Oxygen concentrators & tanks
• CPAP / BiPAP machines
• Nebulizers
• Suction machines
• IV poles
• Shower chairs & commodes

Plus accessories such as:
• Batteries & backup packs
• Tubing & cannulas
• Masks & interfaces
• Chargers & power cords
• Filters & remotes
• Gurneys & transfer boards

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⏱ Rental Details & Delivery Preferences

Defines:
• Requested start date
• Weekly, monthly, long-term, or indefinite rental
• Delivery urgency
• Scheduled delivery windows
• Pickup location (if different)

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🧑⚕️ Client Needs & Special Instructions

Documents:
• Mobility level
• Fall risk
• Transfer requirements
• Oxygen dependency
• Pressure-relief mattress needs
• Home or facility access challenges
• Pets, parking, elevators, stairs, and space constraints

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💳 Payment & Billing Information

Captures:
• Preferred payment method
• Facility billing
• Insurance (if applicable)
• Billing contact

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✍ Authorization

Clean signature blocks for:
• Client or responsible party
• Company representative
• Authorization date

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💼 Who This Intake Form Is For

Perfect for:

✔ Medical equipment rental companies
✔ Durable medical equipment (DME) providers
✔ Home healthcare suppliers
✔ Mobility & accessibility rental businesses
✔ Oxygen & respiratory equipment vendors
✔ Rehab & recovery equipment companies
✔ Hospital & facility equipment providers
✔ Independent medical suppliers

If you rent medical equipment professionally — this form belongs in your workflow.

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🔥 Why Equipment Providers Love This Intake Form

• Prevents delivery and setup mistakes
• Reduces scheduling errors
• Improves estimate accuracy
• Creates smoother delivery days
• Looks professional and organized
• Saves hours vs building intake forms from scratch
• Reusable for unlimited rentals
• Works for residential, commercial & facility clients

This is paperwork that protects your time, your inventory, and your reputation.

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🥷 Final Ninja Note

Great rentals start with great information.

This Medical Equipment Rental Client Intake Form helps you stay organized, avoid costly errors, and operate like a true professional from the very first call.

Add it to your toolkit and start every rental with Ninja-level clarity, control, and confidence. ⚔️