Smile makeover intake that captures gum health up front
Every enquiry captures the smile concerns a patient wants addressed, their current gum and tooth health, and their treatment timeline, plus smile photos, so you can gauge scope before the first consultation lands on your calendar.
The exact intake your smile makeover leads complete
This is the real 5-question guided intake for Smile Makeover — the same flow your customers finish before you ever pick up the phone.
What a qualified smile makeover lead should tell you
A combination cosmetic treatment plan—often blending whitening, veneers, bonding, or reshaping—that the intake needs to scope by identifying which smile concerns a patient wants addressed and their current gum and tooth health.
- Aspects Smile Would Like
- Had Dental Exam Or
- Would Describe Current Gum
- Would Like Begin Smile
- Person Who Will Decide
The questions your team needs answered
Every smile makeover intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What aspects of your smile would you like to improve? | Shows whether the patient needs a single fix or a multi-procedure smile makeover, which shapes how long the consultation should be scheduled for. |
| Have you had a dental exam or cleaning within the past year? | A recent dental exam signals the patient's baseline oral health is already documented, reducing the chance of surprises that delay treatment. |
| How would you describe your current gum and tooth health? | A diagnosed gum disease or active dental problem answer flags the lead for evaluation before cosmetic chair time is booked. |
| When would you like to begin your smile makeover? | Timeline separates patients ready to schedule now from those still just exploring options. |
| Are you the person who will decide on and schedule this treatment? | Confirms whether the person completing the form can actually authorize and schedule the treatment, not just inquire on someone else's behalf. |
How Cliont scores smile makeover leads
Every answer is weighted automatically — no manual review required.
Value signals
- Had Dental Exam Or: yes
- Healthy, no known issues
- Minor issues like sensitivity or small cavities
- Not sure
- Person Who Will Decide: yes
Urgency signals
- Diagnosed gum disease or active dental problems
See the lead your team receives
Smile Makeover 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 smile makeover workflows
| Cliont capability | Smile Makeover application |
|---|---|
| Multi-select concern capture | The smile concerns question lets patients flag color, alignment, chips, missing teeth, shape, or gum appearance together, showing you whether this is a single fix or a full multi-treatment case. |
| Automatic urgency flagging | A reported diagnosis of gum disease or active dental problems routes the lead for evaluation rather than straight into a cosmetic consultation slot. |
| Decision-maker detection | The scheduling-authority question flags non-decision-makers so staff confirm the actual patient before allocating chair time to a consult. |
| Timeline-based prioritization | Treatment timeline answers separate ASAP patients from those just exploring options, so your CRM can apply different outreach speed to each. |
Common smile makeover lead scenarios
Healthy patient, ready now
Recent exam on file, healthy gums, and a decision-maker who wants to start as soon as possible—this combination scores as a strong candidate for a consultation slot.
Diagnosed gum disease flagged
A patient reports active gum disease or dental problems, which the intake flags so staff can route them toward evaluation before allocating cosmetic chair time.
Just exploring, no recent exam
No dental visit within the past year and a 'just exploring options' timeline signal a browser rather than a near-term booking, better suited to nurture follow-up.
Spouse fills out the form
The person submitting isn't the one who will decide on or schedule treatment, so the intake surfaces that gap before front desk confirms an actual patient 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
Smile Makeover lead-intake FAQs
How does the intake handle patients who report diagnosed gum disease?
That answer on the gum and tooth health question is treated as an urgent flag, so you can route the lead toward evaluation instead of scheduling straight into cosmetic chair time.
Can I see which specific smile concerns each patient wants fixed before they arrive?
Yes, the multi-select question captures color, alignment, chipped or worn teeth, missing teeth, shape, and gum appearance, so you know upfront whether this is a single-treatment or multi-procedure case.
What if the person filling out the form isn't the one who will actually book and pay?
The decision-maker question is weighted lower for a 'no' answer, which tells your team to confirm the real patient before committing consultation time.
Does the intake track whether patients have had a recent dental checkup?
Yes, the exam question asks about the past year and weighs a recent visit higher, helping you prioritize patients whose baseline oral health is already documented.
How are 'just exploring' patients handled differently from ready-to-book ones?
The treatment timeline question separates ASAP starters from those still researching, so your CRM can apply a different follow-up cadence instead of pushing everyone toward an immediate consult.
Does this overlap with your veneers or teeth whitening intake pages?
A smile makeover often combines several procedures, so this intake is for patients wanting multiple changes at once; a patient asking only about whitening or veneers is better routed to those specific subservice pages.
Turn smile makeover visitors into qualified patients
Give every smile makeover visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.