Describe your repair intake. Makeform creates a wheelchair repair form for chair details, symptoms, photos, service location, appointment windows, and customer contact preferences.
Route requests to email, Slack, Google Sheets, and Zapier.
Sample prompts for the builder
Choose a workflow and edit it in the builder.
Audience
Power-chair customers
Format
Conditional intake with photos
Prompt size
263 chars
Example form structure
Conditional intake with photos
Customer and caregiver contact details
Chair make, model, and serial number
What happens when you power on or drive?
Photos of the chair, controls, or error display
Preferred appointment windows
Suggested routing tags
Power chair
Manual chair
Appointment requested
Ask what changed, when it started, and whether the chair can still be used.
Step 1
Identify
customer, wheelchair, and service location
Step 2
Describe
symptoms, timing, usability, and photos
Step 3
Route
power, manual, seating, or follow-up queue
Step 4
Schedule
callback, pickup, or appointment windows
Better repair intake
A focused intake replaces vague messages with the equipment identity, observable symptom, current location, and scheduling information a coordinator needs to begin triage.
Separate make, model, serial or asset number, and chair-type fields help staff find the correct equipment record.
Branch by wheelchair type and component into relevant power, control, wheel, brake, frame, seating, or accessory questions.
Send the response, attachments, location, and contact preference to the service workflow for a better-informed callback.
Four practical workflows
Start with the closest service path, then change terminology, routing tags, appointment choices, and required fields to fit your team.
Ask about power state, charging, controls, error indicators, drive behavior, and recent impacts only when a power chair is selected.
Use component choices for wheels, casters, locks, frame, upholstery, foot supports, arm supports, and seating accessories.
Capture the staff contact, room or unit, access instructions, equipment availability, and internal authorization reference in one submission.
Connect the new report to a work order, service date, previous symptom, and fresh photos so the team can compare what changed.
Build the workflow
Describe your repair operation, review the generated questions, and connect each completed request to the people who schedule and perform the work.
List the chair types, service locations, and details each repair queue needs.
Add components, require identification, and show questions based on earlier answers.
Share a link or embed the form so every request follows one structure.
Route submissions, review details, and contact customers using their selected method.
Intake options
Phone and email can still be available, but a structured form gives customers prompts for equipment details and evidence they may otherwise forget to mention.
Field guide
These six sections give coordinators enough context to identify the equipment, understand the report, choose a service path, and arrange the next contact.
Customer and contact
Collect the requester, wheelchair user when different, relevant representative, preferred contact channel, and callback times.
Equipment identity
Use make, model, serial number, asset tag, and chair type. Offer a label-photo upload.
Issue details
Ask what happens, when it began, whether it is intermittent, and which component seems affected—not for a diagnosis.
Evidence
Photos can show damage, an error display, or identification plate. Explain useful angles and avoid unrelated documents.
Current usability
Ask whether the chair is fully usable, difficult to use, or unusable, plus immediate access concerns.
Service logistics
Record address, service preference, access notes, and appointment windows pending coordinator confirmation.
Related tools
Connect repair intake with equipment inspection, maintenance records, service requests, approvals, and follow-up reporting.
Create repeatable inspection checks for equipment condition, components, photos, and notes.
Open toolCollect maintenance tasks, equipment identity, assigned staff, parts, and completion notes.
Open toolBuild a general repair intake for other devices, fixtures, and equipment your team supports.
Open toolGather requester details, service category, description, location, urgency, and contact preferences.
Open toolRoute proposed work, estimates, supporting details, and an approval decision to the right reviewer.
Open toolRecord completed work, parts, dates, technicians, observations, and next-service notes.
Open toolFAQ
Practical answers for mobility equipment providers setting up a clearer repair request and scheduling process.
A wheelchair repair form records a service request in a consistent format: customer, chair identity, observed symptom, usability, location, photos, contact preference, and appointment windows.
Usually require customer, contact method, chair type, identity, location, component, symptom, and usability. Configure serial number, photos, access notes, and appointment windows for your workflow.
Yes. Branch from wheelchair type. Show charging, controls, indicators, and drive questions for power chairs; show wheels, casters, locks, frame, upholstery, and supports for manual chairs.
Ask whether the chair is usable and about impact, smoke, heat, liquid, or unusual odor. Show your own immediate-situation instructions, route flags to a person, and avoid unconfirmed response-time promises.
Yes. Request a full-chair view, issue close-up, identification label, or control display. Video can show movement or sound. Keep uploads optional when customers cannot capture them.
Collect preferred times, location, and service preference. Treat them as requests until a coordinator reviews the issue and confirms the appointment.
Yes. Makeform offers unlimited free forms and responses. You can generate, edit, publish, and collect requests without a response cap; the paid tier removes the Makeform badge.
Use wheelchair type, component, location, and usability as routing tags. Send submissions to your Makeform inbox or connect email, Slack, Google Sheets, or Zapier, including contact preference and attachments.
Replace incomplete repair messages with structured intake.
