Lost filling or crown intake that captures pain and swelling up front
Every enquiry captures whether the tooth is painful, what happened to it (filling fell out, crown fell off, or tooth broke), and whether swelling or infection is present, plus a photo of the tooth and the lost piece if the patient still has it.
The exact intake your lost filling or crown leads complete
This is the real 5-question guided intake for Lost Filling or Crown — the same flow your customers finish before you ever pick up the phone.
What a qualified lost filling or crown lead should tell you
A lost filling or crown case is a patient whose existing restoration has fallen out, come loose, or broken away from the tooth, and the intake needs to capture what happened, whether the tooth hurts, and whether infection signs are present to judge how urgent the repair is.
- Experiencing Pain Or Sensitivity
- Happened Tooth
- Still Have Filling Or
- Soon Be Seen
- Have Swelling, Bad Taste,
The questions your team needs answered
Every lost filling or crown intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Are you currently experiencing pain or sensitivity in the affected tooth? | Active pain or sensitivity is one of the highest-weighted signals, indicating exposed dentin or nerve involvement that raises how urgently the tooth needs attention. |
| What happened to the tooth? | Knowing whether a filling fell out, a crown fell off, or the tooth broke tells your team what materials and chair time the repair will realistically require. |
| Do you still have the filling or crown that came out? | Whether the patient retained the original piece determines if the visit is a simple recement or a full remake, which affects scheduling and lab lead time. |
| How soon are you hoping to be seen? | The desired timing answer is directly weighted, separating same-day requests from patients who are just exploring options so chair time isn't held for low-urgency browsers. |
| Do you have swelling, a bad taste, or other signs of infection near the tooth? | Swelling, bad taste, or other infection signs carry a high weight because they suggest the exposed tooth may already be infected, not just cosmetically compromised. |
How Cliont scores lost filling or crown leads
Every answer is weighted automatically — no manual review required.
Value signals
- Experiencing Pain Or Sensitivity: yes
- Today
- Within a few days
- This week
- Have Swelling, Bad Taste,: yes
See the lead your team receives
Lost Filling or Crown 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 lost filling or crown workflows
| Cliont capability | Lost Filling Or Crown application |
|---|---|
| Weighted scoring | Combines the pain/sensitivity answer and the swelling or infection answer to push same-day requests with visible infection signs to the top of the queue. |
| Branching single-choice logic | The 'what happened to the tooth' question separates filling, crown, and broken-tooth cases so your team can anticipate whether the visit needs a recement, a new crown fabrication, or a restorative repair. |
| Required photo capture | Prompts the patient for a photo of the tooth and, separately, a photo of the retained filling or crown so your front desk can judge repair complexity before the appointment. |
| CRM routing with urgency tags | Sends leads who selected 'Today' or reported swelling into your CRM flagged for same-day follow-up, separate from patients who marked 'Just exploring options.' |
Common lost filling or crown lead scenarios
Crown fell off with swelling
Patient reports pain and swelling near the tooth and wants to be seen today, matching the intake's highest-value signals for same-day chair time.
Filling out, no pain, browsing
Patient lost a filling but has no pain or swelling and is just exploring options, so the intake flags this as lower urgency without discarding the lead.
Tooth broke with the crown
Patient's tooth broke along with the restoration and they still have the crown, giving your team a clear picture of what to bring them in for and what to prepare chairside.
Bad taste, wants same-day slot
Patient describes a bad taste near the affected tooth alongside wanting to be seen today, a combination the intake weighs as high priority even without reported pain.
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
Lost Filling or Crown lead-intake FAQs
Does the intake tell us whether it was a filling or a crown that came out?
Yes, the catalog asks directly what happened to the tooth, with options for filling fell out, crown fell off, tooth broke along with the restoration, or not sure, so your team knows what kind of repair to prep for before the patient arrives.
How does the intake handle patients who don't have the filling or crown anymore?
The catalog asks whether the patient still has the piece that came out; if they don't, your team knows in advance that a full replacement or new impression will likely be needed rather than a simple recement.
Why does swelling or bad taste raise the priority of a lost filling or crown lead?
Swelling, bad taste, or other infection signs near the affected tooth are weighted highly in this catalog because they can indicate the exposed tooth structure has become infected, which changes how quickly the case should be seen.
How is a lost filling or crown lead different from a severe toothache lead in your library?
This intake is built around a specific triggering event, what happened to the restoration and whether the patient kept it, while the Severe Toothache subservice qualifies pain on its own without that restoration-specific context.
What if the patient says they're just exploring options rather than wanting to be seen today?
The urgency question captures that directly with a dedicated 'just exploring options' choice, so your team can route these leads for follow-up rather than treating them as same-day chair-time requests.
What photos should we ask patients to upload for a lost filling or crown case?
Ask for a photo of the affected tooth and gum area, and a photo of the lost filling or crown itself if the patient still has it, so your team can assess the damage before booking.
Turn lost filling or crown visitors into qualified patients
Give every lost filling or crown visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.