Know which dental injury leads are worth consultation time
Ask about injury type, time since the injury, and whether pain or bleeding is present, plus photos of the damage, so you know which dental injury enquiries need a same-day appointment.
The exact intake your dental injury leads complete
This is the real 6-question guided intake for Dental Injury — the same flow your customers finish before you ever pick up the phone.
What a qualified dental injury lead should tell you
Urgent intake for patients who have suffered trauma to a tooth, gum, lip, tongue, or jaw, capturing what happened, when, and whether the patient can be seen today so staff can triage true emergencies from cases already treated elsewhere.
- Best Describes Injury
- Long Ago Did Injury
- Patient Experiencing Pain Or
- Injury
- Already Seen Dentist Or
- Able Bring Patient In
The questions your team needs answered
Every dental injury intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What best describes the injury? | The type of injury sets the baseline urgency, since a full avulsion carries different treatment stakes than a chip or a soft-tissue cut. |
| How long ago did the injury happen? | Time since injury matters most for a knocked-out or loosened tooth, since replantation odds drop quickly the longer it waits. |
| Is the patient currently experiencing pain or bleeding? | Active pain or bleeding signals the injury is not yet stable and pushes the lead toward urgent handling. |
| Who is the injury for? | Knowing whether the patient is a child, an adult, or a dependent lets staff prepare the right chairside approach before the visit. |
| Have you already seen a dentist or emergency room for this injury? | A prior ER or dentist visit means the case may already be stabilized, keeping true untreated emergencies from being crowded out. |
| Are you able to bring the patient in for care today? | Same-day availability tells staff whether to hold urgent chair time now or schedule a follow-up visit instead. |
How Cliont scores dental injury leads
Every answer is weighted automatically — no manual review required.
Value signals
- Tooth knocked out completely
- Tooth loosened or shifted
- Cut to gum, lip, or tongue
- Jaw pain from impact
- Other
- Within the last hour
Urgency signals
- Tooth chipped or broken
See the lead your team receives
Dental Injury 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 dental injury workflows
| Cliont capability | Dental Injury application |
|---|---|
| Automatic lead scoring | Weighs injury type against time since injury so a tooth knocked out within the last hour outranks a chipped tooth reported days later. |
| Photo capture widget | Lets the patient show the socket, a loosened tooth, or a cut lip or tongue before staff return the call. |
| Conditional intake logic | Flags whether the patient has already been seen by an ER or another dentist so you don't hold open urgent chair time for a case already treated. |
| Same-day availability capture | Separates patients who can come in today from those needing a scheduled slot, so front desk staff can prioritize true walk-in emergencies. |
| Dependent-vs-self field | Distinguishes a parent reporting a child's injury from an adult self-reporting, so staff can prepare pediatric-specific chairside handling in advance. |
Common dental injury lead scenarios
Tooth knocked out within the hour
Injury type is a full avulsion and the incident happened within the last hour, so the intake flags it for immediate same-day chair time given the narrow replantation window.
Chipped tooth reported days later
The injury occurred several days ago and the patient already saw an emergency room, so the intake routes it as a lower-urgency follow-up rather than a walk-in emergency.
Parent reporting a child's injury
The 'who is this for' answer identifies a child, letting staff prepare pediatric-specific chairside handling before the family arrives.
Jaw pain with no visible bleeding
Jaw pain from impact with no active bleeding still scores as a real trauma case, but the intake surfaces it differently than an active bleeding emergency so staff can judge whether imaging is needed.
Cut lip, patient can't come in today
A soft-tissue injury combined with a 'no' on same-day availability tells staff this lead needs scheduling outreach rather than an urgent slot held open.
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 emergency dentistry intake templates
Dental Injury lead-intake FAQs
How does the intake decide if a knocked-out tooth needs same-day chair time?
It combines the injury type answer with how long ago it happened and whether the patient can come in today, so a tooth knocked out within the last hour is flagged well ahead of a chip reported days later.
What happens if the patient already went to an emergency room?
The intake asks whether the patient has already been seen for the injury, which lets staff treat the enquiry as a follow-up rather than holding open urgent chair time for a case already triaged elsewhere.
Can this intake be filled out by a parent for a child's injury?
Yes, the intake asks who the injury is for, so responses submitted on behalf of a child or another dependent are clearly labeled before staff call back.
Does reporting pain or bleeding change how the lead is routed?
Yes, active pain or bleeding is weighted as an urgent signal, separating it from cases where the injury happened but the patient is currently stable.
How is this different from your knocked-out tooth intake?
Knocked-Out Tooth is a narrower, single-symptom intake, while Dental Injury covers the full range of trauma, chips, loosened teeth, soft-tissue cuts, and jaw impact, in one form.
What photos should patients submit with a dental injury enquiry?
Ask for a photo of the injured tooth or socket, any avulsed tooth if it was saved, and a photo of any cut to the lip, gum, or tongue so staff can assess severity before the patient arrives.
Turn dental injury visitors into qualified patients
Give every dental injury visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.