Know which cosmetic bonding leads are worth consultation time
Patients tell you upfront whether it's a chip, gap, discoloration, or shape issue, how many teeth are involved, and when they last had an exam — with photos of the affected teeth attached before the request ever hits your calendar.
The exact intake your cosmetic bonding leads complete
This is the real 6-question guided intake for Cosmetic Bonding — the same flow your customers finish before you ever pick up the phone.
What a qualified cosmetic bonding lead should tell you
Cosmetic bonding uses tooth-colored composite resin to repair chips, gaps, discoloration, or minor shape irregularities on one or more teeth, without the lab turnaround veneers or crowns require.
- Main Concern Want Addressed
- Many Teeth Considering Having
- Had Dental Exam Or
- Have Any Active Tooth
- Soon Would Like Schedule
- Person Receiving Treatment Or
The questions your team needs answered
Every cosmetic bonding intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main concern you want addressed with bonding? | The specific concern (chip, gap, discoloration, or shape) tells the front desk what shade-matching or contouring to prepare for before the consultation. |
| How many teeth are you considering having bonded? | Knowing whether it's one tooth or five-plus teeth lets the practice plan the right amount of chair time instead of guessing at scope. |
| Have you had a dental exam or x-ray in the past 12 months? | A recent exam suggests the tooth is structurally ready for bonding, while no recent exam signals the patient may need x-rays before treatment can proceed. |
| Do you have any active tooth pain or sensitivity in the affected teeth? | Active pain or sensitivity points to a possible underlying issue that needs clinical evaluation, not just a cosmetic shade-matching consult. |
| How soon would you like to schedule this treatment? | Timeline shows whether the patient is ready to book now or still comparing options, which helps the team decide who to follow up with first. |
| Are you the person receiving treatment or a parent/caregiver scheduling for someone else? | Whether the patient is scheduling for themselves or a dependent changes who needs to be reached to confirm the appointment and consent. |
How Cliont scores cosmetic bonding leads
Every answer is weighted automatically — no manual review required.
Value signals
- Chipped or cracked tooth
- Gaps between teeth
- Discoloration or staining
- Uneven shape or size
- Not sure
- Had Dental Exam Or: yes
See the lead your team receives
Cosmetic Bonding 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 cosmetic bonding workflows
| Cliont capability | Cosmetic Bonding application |
|---|---|
| Branching logic | When a patient selects 'Not sure' for their main concern, the intake can prompt for a photo upload so your team can assess the tooth before the consult instead of guessing at the case type. |
| Lead scoring | Combines the number of teeth involved with recent exam history so a five-plus-teeth case with no exam on file is surfaced differently than a single-tooth touch-up ready to book. |
| Photo upload widget | Captures a close-up of the chipped, gapped, or discolored tooth so your team can start shade planning before the patient walks in. |
| CRM routing | Sends each qualified bonding consultation to your CRM tagged with the concern type and teeth count, so your scheduling team can slot it against the right amount of chair time. |
Common cosmetic bonding lead scenarios
Single chip, ready now
Patient reports one chipped tooth, confirms a recent dental exam, and wants to schedule as soon as possible — a straightforward case the intake flags as fast to fit into open chair time.
Full-mouth bonding inquiry
Patient selects five or more teeth for discoloration but hasn't had an exam in the past year — the intake surfaces both the larger case size and the outstanding exam before it's booked as a routine consult.
Pain reported alongside cosmetic ask
Patient wants gaps closed but also flags active tooth pain or sensitivity — the intake separates this from a routine shade-matching request so the front desk can route it for a clinical check first.
Caregiver booking for a teen
A parent selects 'parent or caregiver' and chooses a chipped tooth as the concern for a dependent — the intake captures that the decision-maker and the patient are different people, which changes who needs to be reached to confirm the appointment.
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 cosmetic dentistry intake templates
Cosmetic Bonding lead-intake FAQs
How does the intake handle a patient who mentions tooth pain along with a cosmetic request?
The intake asks separately about active pain or sensitivity, so a patient wanting a chip fixed who also reports pain gets flagged for clinical review rather than being treated as a routine shade-matching consult.
Can I tell from the intake whether it's a one-tooth touch-up or a larger case?
Yes — the intake asks how many teeth the patient is considering having bonded, from one tooth up to five or more, so you can see case size before blocking chair time.
What happens if a patient hasn't had a recent dental exam or x-ray?
The intake records whether the patient has had an exam or x-ray in the past 12 months; if not, that's visible on the lead so your team can confirm the tooth is a good candidate for bonding before committing a full consult slot.
Will this intake catch patients who actually want veneers or a full smile makeover instead of bonding?
The concern options are specific to bonding-appropriate issues like chips, gaps, discoloration, and shape — a patient describing something more extensive can be redirected to your Dental Veneers or Smile Makeover intake instead.
How are requests submitted by a parent or caregiver handled?
The intake asks whether the person filling it out is the patient or a caregiver scheduling for someone else, so your team knows upfront who to contact to confirm the appointment and who will actually be in the chair.
Turn cosmetic bonding visitors into qualified patients
Give every cosmetic bonding visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.