Know which gum disease screening leads are worth consultation time
The intake asks patients about gum bleeding, swelling, or receding gums, prior gum disease diagnosis, and how long since their last cleaning, then collects a quick photo of their gums so your team can see which consultations to prioritize.
The exact intake your gum disease screening leads complete
This is the real 5-question guided intake for Gum Disease Screening — the same flow your customers finish before you ever pick up the phone.
What a qualified gum disease screening lead should tell you
A screening intake that checks for bleeding, swelling, receding gums, and prior gum disease history to determine whether a patient needs a periodontal consultation.
- Noticing Bleeding, Swelling, Or
- Noticed Persistent Bad Breath
- Been Diagnosed With Gum
- Was Last Dental Cleaning
- Smoke Or Use Tobacco
The questions your team needs answered
Every gum disease screening intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Are you noticing bleeding, swelling, or receding gums? | This carries the highest weight in the catalog (9), since active bleeding, swelling, or receding gums is the clearest sign of disease in progress. |
| Have you noticed persistent bad breath or a bad taste in your mouth? | Persistent bad breath is weighted at 6 as a secondary indicator, catching cases where bacterial buildup exists without visible bleeding. |
| Have you been diagnosed with gum disease before? | This distinguishes a relapsed, untreated diagnosis (weight 9) from a resolved one (weight 7), telling staff whether this is a recurrence or a maintained condition. |
| When was your last dental cleaning or checkup? | Time since last cleaning isn't weighted but gives the hygienist context on how overdue the patient is for professional care. |
| Do you currently smoke or use tobacco products? | Tobacco use is captured as clinical context rather than a scored signal, since it informs treatment planning without itself indicating active gum disease. |
How Cliont scores gum disease screening leads
Every answer is weighted automatically — no manual review required.
Value signals
- Noticing Bleeding, Swelling, Or: yes
- Noticed Persistent Bad Breath: yes
- Yes, and it was treated
- Yes, but not treated
- No
- Not sure
See the lead your team receives
Gum Disease Screening 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 gum disease screening workflows
| Cliont capability | Gum Disease Screening application |
|---|---|
| Weighted answer scoring | Bleeding, swelling, or receding gums (weight 9) and persistent bad breath (weight 6) are scored above unconfirmed history answers, so symptomatic patients rise to the top. |
| Context fields without score impact | Tobacco use and last cleaning date are captured but not weighted, keeping the score focused on active symptoms while still giving staff useful clinical background. |
| Photo upload widget | Collects a gum close-up photo before the visit so the hygienist can review it ahead of assigning chair time. |
| CRM routing | Sends the scored gum disease screening lead directly into your CRM, distinct from routine cleaning or new patient exam requests. |
| Lead scoring bands | Separates a 'yes, but not treated' prior diagnosis (weight 9) from a 'yes, and it was treated' history (weight 7), flagging relapsed cases as higher priority than resolved ones. |
Common gum disease screening lead scenarios
Untreated gum disease, symptomatic
Patient reports active bleeding and swelling, was diagnosed before but never treated, and hasn't been seen in over a year. The intake flags this as a high-priority relapse case.
Bad breath, no bleeding
Patient notices persistent bad breath but no visible bleeding or swelling and has no prior diagnosis. Scored lower than symptomatic bleeding cases but still surfaced for review.
Routine preventive check
Patient answers no to bleeding, bad breath, and prior diagnosis, and is current on cleanings. The intake routes this as a lower-priority lead better suited to a routine cleaning.
Uncertain history, mild symptoms
Patient answers 'not sure' about a past diagnosis and isn't sure when their last cleaning was, alongside mild bleeding. The intake surfaces this as a mid-range lead needing clarification before booking.
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
Gum Disease Screening lead-intake FAQs
How does the intake tell the difference between a routine cleaning request and a gum disease screening lead?
The bleeding/swelling question and bad breath question carry the highest weights, so a patient reporting either is scored above someone with no symptoms who would be better matched to a Routine Dental Cleaning.
Does the intake ask about smoking or tobacco use?
Yes, but that answer isn't weighted in the score. It's captured as clinical context so your team has it on hand for treatment planning without inflating or lowering lead priority.
What happens if a patient says they're 'not sure' whether they've been diagnosed with gum disease before?
That answer carries a mid-range weight of 5, placing the lead between a confirmed untreated diagnosis (weight 9) and a first-time patient with no history (weight 4), so it still surfaces for follow-up rather than getting buried.
Can gum disease screening leads route into the same CRM as my New Patient Dental Exam leads?
Yes, every scored lead from this intake is sent to your CRM, so front desk staff can see both alongside each other and prioritize chair time accordingly.
Will patients with no symptoms still show up as leads?
Yes, a 'no' answer to bleeding or swelling still carries a weight and generates a scored lead, just lower priority than a patient showing active symptoms.
Do patients need to upload a photo before booking?
The intake requests a close-up photo of the gums so your hygienist has a visual reference before the patient arrives, in addition to the symptom and history questions.
Turn gum disease screening visitors into qualified patients
Give every gum disease screening visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.