Dental X-ray intake that captures the reason for imaging up front
Guide patients through why they need X-rays, who the appointment is for, and how soon they need it in—then flag any prior X-ray images or dental records they can share, so qualified requests land in your CRM ready to schedule.
The exact intake your dental x-rays leads complete
This is the real 5-question guided intake for Dental X-Rays — the same flow your customers finish before you ever pick up the phone.
What a qualified dental x-rays lead should tell you
A diagnostic imaging request where a patient needs dental X-rays taken to evaluate teeth, gums, or jaw structures, typically tied to a specific symptom, injury, or routine screening need.
- Main Reason Dental X-Rays
- This X-Ray
- New Dentist Provide This
- Soon Have X-Rays Done
- Have Any Existing Dental
The questions your team needs answered
Every dental x-rays intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason you need dental X-rays? | The stated reason for imaging separates a routine screening from a suspected infection, letting you prioritize same-day cases over standard scheduling. |
| Who is this X-ray for? | Knowing whether the appointment is for the patient, a child, or another dependent changes intake, consent, and chart-pull requirements before the visit. |
| Are you currently looking for a new dentist to provide this X-ray service? | This flags whether the lead is actively shopping for a new dentist, which matters for tracking new-patient acquisition versus existing relationships. |
| How soon are you looking to have the X-rays done? | Timeline reveals true urgency separately from the stated reason, so a pain-driven ASAP request can be triaged ahead of a within-a-month checkup. |
| Do you have any existing dental records or prior X-ray images available to share? | Confirming whether prior X-ray images or records exist helps avoid unnecessary re-imaging and speeds up diagnosis at the first visit. |
How Cliont scores dental x-rays leads
Every answer is weighted automatically — no manual review required.
Value signals
- Routine checkup or cleaning
- Tooth pain or discomfort
- Injury or trauma to mouth
- Orthodontic or treatment planning
- Suspected infection or abscess
- Not sure
See the lead your team receives
Dental X-Ray 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 x-rays workflows
| Cliont capability | Dental X-Rays application |
|---|---|
| Reason-based triage | A reason of suspected infection or abscess is weighted highest, so those leads can be flagged for faster follow-up than a routine checkup request. |
| Dependent identification | The 'who is this for' field tells front desk staff whether to pull the patient's own chart or prepare intake for a child or other dependent. |
| Urgency-based scheduling | The ASAP timeline answer for pain or injury cases lets you offer same-day or next-day slots instead of standard booking windows. |
| Existing patient detection | The yes/no question on actively looking for a new dentist helps you separate new-patient acquisition opportunities from casual inquiries. |
| Records pre-check | Asking whether prior X-ray images or dental records exist lets your team prepare for the visit and avoid redundant imaging requests. |
Common dental x-rays lead scenarios
Sudden tooth pain flare-up
Patient selects tooth pain as the reason and needs imaging as soon as possible, so the intake surfaces this as a same-day priority instead of a routine slot.
Injury or trauma to mouth
A fall or accident prompts an urgent request, distinct from a pain complaint, and the intake still routes it for immediate attention based on the ASAP timeline answer.
Routine annual checkup
Patient picks routine checkup as the reason with a timeline of within a month, signaling a lower-urgency but still valuable long-term patient for standard scheduling.
Parent booking for a child
The 'who is this for' field is set to child rather than self, alerting front desk staff to different intake and consent handling before the visit.
Shopping for a new dentist
Patient confirms they're actively looking for a new provider and may have prior X-ray images to share, flagging a switch-worthy new-patient opportunity.
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 general dentistry intake templates
Dental X-Rays lead-intake FAQs
Does the intake capture why the patient needs X-rays before they book?
Yes. The intake asks for the main reason, ranging from routine checkups to suspected infection or trauma, so you can see the clinical context before offering chair time.
Can the form tell me if the X-ray is for the patient or their child?
Yes. A dedicated field captures whether the appointment is for the patient themselves, their child, or another dependent they care for.
How does the intake handle a patient with active pain or a recent injury?
The timeline question captures whether the patient needs imaging as soon as possible due to pain or injury, which raises the lead's priority for faster scheduling.
Will patients be asked if they already have prior X-ray images or dental records?
Yes. A yes/no question checks for existing records, helping your team avoid unnecessary re-imaging and prepare faster for the first visit.
Does the intake distinguish new patients from those already established at another practice?
Yes. A yes/no question asks whether the patient is currently looking for a new dentist to provide this service, which helps you separate switch-worthy leads from existing referrals.
Is this the same intake used for other general dentistry services like cleanings or fillings?
No. Each subservice, including Routine Dental Cleaning and Tooth Filling, has its own qualification catalog tailored to that service's specific fields.
Turn dental x-rays visitors into qualified patients
Give every dental x-rays visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.