Know which preventive dentistry leads are worth consultation time
Ask new and returning patients about visit type, pain or sensitivity, and how soon they want to be seen, then collect a photo of their insurance card before the lead ever reaches your CRM.
Preview your preventive dentistry intake
Explore 7 questions from the Preventive Dentistry template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified preventive dentistry lead should tell you
Routine exams, cleanings, and checkups intended to catch cavities and gum problems early, distinct from visits driven by an active complaint like a cracked tooth or infection.
- This Appointment
- Visit
- Long Has It Been
- Experiencing Any Pain, Sensitivity,
- Have Dental Insurance Plan
- Soon Would Like Schedule
- There Any Specific Areas
The questions your team needs answered
Every preventive dentistry intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this appointment for? | Knowing whether the visit is for the patient, their child, or another adult changes which consent and scheduling flow front desk needs to prepare. |
| What type of visit are you looking for? | Visit type separates a straightforward cleaning from a first-visit workup or a concern-driven exam, each needing different chair time. |
| How long has it been since the last dental checkup? | Segments the lead so you can route, price, and prioritize it correctly. |
| Are you currently experiencing any pain, sensitivity, or discomfort? | A yes answer on pain or sensitivity signals the visit may need same-day or sooner attention rather than a standard preventive slot. |
| Do you have dental insurance you plan to use for this visit? | Insurance status tells front desk whether a benefits check is needed before the appointment can be confirmed. |
| How soon would you like to schedule this appointment? | How soon the patient wants to be seen determines whether the lead should be prioritized for the next open slot or a later recall. |
| Are there any specific areas or teeth you would like the dentist to check? | Free-text notes on specific teeth give the dentist advance context on what to examine before the patient sits down. |
How Cliont scores preventive dentistry leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Routine cleaning and checkup
- First visit as a new patient
- Specific concern noticed recently
- Not sure
- Experiencing Any Pain, Sensitivity,: yes
- As soon as possible
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Preventive Dentistry 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 preventive dentistry workflows
| Cliont capability | Preventive Dentistry application |
|---|---|
| Conditional lead scoring | Weights answers on visit type and current pain or sensitivity together so a routine cleaning with no discomfort scores differently than a specific-concern visit with active pain. |
| Structured relationship field | Captures who the appointment is for (self, child, or another adult) so front desk can prep the right consent forms and scheduling flow before the call. |
| CRM sync | Sends insurance status and requested scheduling window straight into the CRM so staff aren't chasing that detail during the confirmation call. |
| Free-text capture | Routes the patient's notes on specific teeth or areas of concern directly to the dentist's notes ahead of the visit. |
Example preventive dentistry lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Overdue recall patient
A patient who hasn't been in for over a year books a routine cleaning with no pain reported, which the intake flags as a recall candidate rather than an urgent slot.
New patient first visit
Someone books their first checkup as a new patient and answers 'over a year' on last visit timing, giving front desk enough context to prep a longer new-patient slot.
Sensitivity during a checkup booking
A patient requests a routine visit but answers yes to current sensitivity and notes a specific tooth in the free-text field, prompting staff to plan extra chair time.
Parent booking for a child
The 'who is this appointment for' answer comes back as 'my child,' which changes what front desk needs to confirm before scheduling versus an adult self-booking.
Uninsured patient exploring cost
A patient selects 'no insurance' and 'not sure' on visit type, signaling the front desk should have a cost conversation ready before confirming the appointment.
Connect Cliont to your workflow
Connect your CRM
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Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
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
Preventive Dentistry lead-intake FAQs
How does the intake separate a routine cleaning from a pain-driven visit?
The visit-type question captures whether someone wants a routine cleaning, a first-visit checkup, or is coming in for a specific concern, and this is combined with the separate yes/no pain and sensitivity question so front desk can tell a preventive booking from a symptomatic one before calling back.
Can the intake tell if the appointment is for a child versus an adult?
Yes, the first question asks whether the visit is for the patient themselves, their child, or another adult they care for, so staff know before the call whether they're scheduling a pediatric or adult slot.
Does the intake collect insurance status before the visit?
It asks directly whether the patient has dental insurance, doesn't have insurance, or isn't sure, which lets front desk staff decide whether a benefits check is needed before the appointment is confirmed.
Why would a 'not sure' answer on visit type still count as a strong lead?
Patients who select 'not sure' on visit type are still weighted as a genuine lead because they've engaged enough to start the intake and typically need a short follow-up call rather than being dismissed as unqualified.
How does the intake handle scheduling urgency for preventive visits?
A dedicated question asks how soon the patient wants to be seen, from as soon as possible to flexible with no rush, so unused chair time doesn't get held for someone who was never in a hurry.
Can patients flag a specific tooth or area before the appointment?
Yes, the free-text question lets patients describe any specific areas or teeth they want the dentist to check, giving the practice advance notice before the patient arrives.
Turn preventive dentistry visitors into qualified patients
Give every preventive dentistry visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.