Toothache intake that flags swelling and fever before you book
Patients rate their pain level, flag swelling or fever, and note whether the tooth is broken or loose, with photos attached, so your team sees the real urgency before offering chair time.
Preview your severe toothache intake
Explore 7 questions from the Severe Toothache template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified severe toothache lead should tell you
Urgent intake for intense, ongoing tooth pain where the practice needs to know pain severity, swelling, fever, and tooth condition before deciding how fast to get the patient into a chair.
- Would Describe Current Pain
- Have Swelling In Face,
- Have Fever Along With
- Affected Tooth Broken, Chipped,
- Soon Be Seen
- Established Patient At Dental
- This Appointment
The questions your team needs answered
Every severe toothache intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How would you describe your current pain level? | The pain-level scale is the primary severity signal and separates a mild intermittent ache from someone who cannot function normally. |
| Do you have swelling in your face, gums, or jaw? | Facial, gum, or jaw swelling is weighted heavily because it often signals a spreading infection rather than isolated tooth pain. |
| Do you have a fever along with the tooth pain? | A fever alongside tooth pain raises the likelihood of systemic infection, which changes how quickly the case should be seen. |
| Is the affected tooth broken, chipped, or knocked loose? | A broken, chipped, or loosened tooth shifts the visit from pain management toward structural repair, affecting scheduling and staffing. |
| How soon do you need to be seen? | Segments the lead so you can route, price, and prioritize it correctly. |
| Are you currently an established patient at a dental office? | Knowing whether the patient is already established lets staff decide if new-patient steps are needed before the first call. |
| Who is this appointment for? | Whether the appointment is for the patient, a child, or another dependent changes consent and history requirements ahead of the visit. |
How Cliont scores severe toothache leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Mild, comes and goes
- Moderate, noticeable most of the day
- Unbearable, cannot function normally
- Have Swelling In Face,: yes
- Have Fever Along With: yes
- Affected Tooth Broken, Chipped,: yes
Urgency signals
- Severe, constant pain
- Affected Tooth Broken, Chipped,
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Severe Toothache 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 severe toothache workflows
| Cliont capability | Severe Toothache application |
|---|---|
| Weighted answer scoring | Combines the pain-level scale, swelling, and fever answers into a single urgency score instead of treating pain as the only factor. |
| Photo and video capture | Collects an image of visible swelling or the broken tooth so staff can visually confirm severity before calling the patient back. |
| Conditional routing | Flags whether the patient is an established patient so your team can branch new-patient intake steps without an extra phone call. |
| Appointment-for field | Separates leads booked for the patient themselves from those booked for a child or dependent, which changes how the consultation is prepared. |
Example severe toothache lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Swelling with fever present
The patient reports facial or jaw swelling alongside a fever, two signals the catalog weights heavily, so the intake surfaces this combination as a likely infection needing same-day attention.
Broken tooth from an accident
Pain is paired with a broken or knocked-loose tooth, which shifts the case from a pain-management visit toward a structural repair that needs to be scheduled and staffed differently.
Not an established patient
Someone in severe pain has never been seen at the practice, so the intake captures that up front and lets you decide whether new-patient paperwork or a faster path is more appropriate.
Booking for a child
The person filling out the form is a parent describing their child's pain rather than their own, changing how consent, history, and the appointment itself need to be handled.
Mild, intermittent pain
Pain is described as mild and comes-and-goes with no swelling or fever, a lower-severity combination the intake can route toward a standard consultation instead of urgent chair time.
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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
Severe Toothache lead-intake FAQs
How does the intake treat swelling and fever answers differently from pain level alone?
Swelling and fever are each scored on their own, separate from the pain-level question, because either one can point to a spreading infection even if the patient's reported pain is only moderate.
What happens if the patient isn't currently an established patient at any dental office?
The intake asks this directly so your front desk knows before the call whether new-patient intake steps are needed, instead of discovering it mid-conversation.
Can the form tell us if someone is booking for their child rather than themselves?
Yes, the intake asks who the appointment is for, so leads for a child or another dependent are flagged distinctly from adult self-bookings before they hit your CRM.
What photos does the intake collect for a broken or chipped tooth?
Patients are prompted to upload a close-up of the affected tooth and, if relevant, a photo of any visible facial or gum swelling, so your team can assess severity before the patient arrives.
How is urgency handled when a patient says the pain is unbearable but wants to be seen this week rather than today?
Pain severity and the requested timeframe are captured as separate answers, so a high pain score with a slower requested timeline still surfaces clearly instead of being averaged away.
How does this differ from the Dental Abscess or Broken or Chipped Tooth intake pages?
This intake is built around pain severity as the entry point, while Dental Abscess and Broken or Chipped Tooth lead with their own specific catalogs; a patient describing broken-tooth trauma alongside pain will still surface that detail here through the tooth-condition question.
Turn severe toothache visitors into qualified patients
Give every severe toothache visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.