Turn knocked-out tooth enquiries into consultation-ready leads
Ask how long ago the tooth was knocked out, how it's being stored, and whether it's a permanent or baby tooth, then have patients upload a photo before you decide whether to open a chair slot.
The exact intake your knocked-out tooth leads complete
This is the real 6-question guided intake for Knocked-Out Tooth — the same flow your customers finish before you ever pick up the phone.
What a qualified knocked-out tooth lead should tell you
A tooth completely displaced from its socket, where the window since the injury, how the tooth has been stored, and whether it's a permanent or baby tooth determine whether replantation is still viable.
- Long Ago Did Tooth
- Still Have Tooth Available
- Tooth Being Stored
- Whose Tooth Was Knocked
- This Permanent (Adult) Tooth
- There Any Other Injuries
The questions your team needs answered
Every knocked-out tooth intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How long ago did the tooth get knocked out? | Replantation success drops the longer the tooth is out of the socket, so this timing bucket is the single strongest driver of the lead's score. |
| Do you still have the tooth available? | Whether the tooth is still available determines if replantation is even on the table, which is why it carries its own weight independent of timing. |
| How is the tooth currently being stored? | Storage medium affects how much viability the tooth has left, giving your team context to judge how much urgency remains beyond the raw time elapsed. |
| Whose tooth was knocked out? | Knowing whose tooth it is clarifies whether guardian consent or pediatric handling applies before the patient is booked. |
| Was this a permanent (adult) tooth or a baby tooth? | Permanent teeth are worth attempting to save while baby teeth typically are not, so this answer changes what the visit is actually for. |
| Are there any other injuries to the face, jaw, or mouth? | A yes here flags cases that may need broader trauma evaluation alongside or instead of the dental visit. |
How Cliont scores knocked-out tooth leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 30 minutes ago
- 30 minutes to 2 hours ago
- 2 to 6 hours ago
- Still Have Tooth Available: yes
- Permanent (adult) tooth
- Baby tooth
See the lead your team receives
Knocked-Out Tooth 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 knocked-out tooth workflows
| Cliont capability | Knocked-Out Tooth application |
|---|---|
| Weighted scoring engine | Combines the time-elapsed bucket, tooth-availability answer, and permanent-vs-baby answer into a single score so a fresh, available, adult-tooth case ranks above a delayed or baby-tooth case automatically. |
| Photo upload capture | Collects an image of the tooth and socket alongside the storage-method answer so staff can visually confirm condition before the patient arrives. |
| CRM routing | Sends the completed knocked-out tooth record, including tooth-type and injury flags, straight into your CRM so the front desk isn't reconstructing the case from a voicemail. |
| Conditional field logic | Surfaces the facial/jaw injury question as a distinct flag so a case with additional trauma is visibly different from a straightforward single-tooth knockout. |
Common knocked-out tooth lead scenarios
Fresh adult tooth, stored in milk
Under 30 minutes since injury, tooth available and kept in milk or saline — the intake flags this as the highest-value case where every minute affects replantation odds.
Delayed call, tooth still in hand
Patient reports the injury happened 2-6 hours ago but still has the tooth in saliva or dry storage; the intake still routes it in but with a lower urgency weight than the fresh case.
Parent calling about a baby tooth
A child's baby tooth was knocked out; the intake separates this from adult-tooth cases since replantation is rarely attempted and expectations for the visit differ.
Tooth lost, adult patient
The tooth itself was never recovered, so the yes/no availability answer drops the score and the case is treated as a socket-management visit rather than a replantation attempt.
Knockout plus facial trauma
Patient reports other injuries to the face or jaw alongside the missing tooth, which the intake surfaces separately so staff can judge whether ER care is needed before or alongside the dental visit.
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
Knocked-Out Tooth lead-intake FAQs
Why does the intake ask how long ago the tooth was knocked out instead of just when the patient can come in?
Tooth survival for replantation drops sharply with time, so the catalog weighs the under-30-minute answer highest and every later bucket lower, letting your team see at a glance how much runway is left.
What happens if the patient no longer has the tooth?
The yes/no availability question carries its own weight separate from timing, so a lost tooth still creates a valid lead — it just scores lower because the visit becomes about socket care rather than replantation.
Does the intake distinguish a baby tooth from a permanent tooth?
Yes — the tooth-type question is weighted separately, since permanent teeth are worth attempting to save while baby teeth typically are not, and that changes what the visit is for.
How does the storage-method answer get used if it isn't scored numerically?
Storage method (socket, milk/saline, saliva, dry) doesn't carry a weight of its own, but it's shown to your team alongside the timing answer to help judge how viable the tooth likely still is.
How is this different from the Dental Injury intake in this library?
Knocked-Out Tooth is a specific case within the broader Dental Injury category — this intake asks the tooth-specific questions (storage, availability, tooth type) that a general injury form wouldn't capture.
Does the intake ask about other injuries beyond the tooth?
Yes, there's a direct yes/no question on other facial or jaw injuries, which helps your team flag cases that may need broader trauma evaluation alongside the dental visit.
Turn knocked-out tooth visitors into qualified patients
Give every knocked-out tooth visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.