Routine cleaning intake that asks what your team actually needs to
Ask patients how long it's been since their last cleaning, whether they're in pain, and how soon they want to come in, before your front desk spends time confirming a slot for someone still just exploring options.
The exact intake your routine dental cleaning leads complete
This is the real 5-question guided intake for Routine Dental Cleaning — the same flow your customers finish before you ever pick up the phone.
What a qualified routine dental cleaning lead should tell you
A preventive visit where the intake needs to know who the cleaning is for, how overdue the patient is, whether pain is present, and how soon they want an appointment.
- This Cleaning
- Was Last Dental Cleaning
- Experiencing Any Tooth Or
- Soon Would Like Schedule
- There Anything Specific 'D
The questions your team needs answered
Every routine dental cleaning intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this cleaning for? | Determines whether this is a self-booking, a child booking, or a caregiver booking for another adult, which changes the scheduling and consent flow needed. |
| When was the last dental cleaning done? | How overdue the patient is on cleanings carries the heaviest weights in the catalog, making it the core signal for prioritizing outreach. |
| Are you currently experiencing any tooth or gum pain? | A yes answer here flags a patient who may need attention beyond a standard cleaning slot, even though it isn't a scored weight. |
| How soon would you like to schedule this cleaning? | Separates patients wanting an appointment immediately from those just exploring options, which is the clearest urgency signal on this intake. |
| Is there anything specific you'd like the dentist to know before your visit? | Captures open-ended context the patient wants the dentist to know, giving staff detail no structured question would surface. |
How Cliont scores routine dental cleaning leads
Every answer is weighted automatically — no manual review required.
Value signals
- Within the last 6 months
- 6 to 12 months ago
- Over a year ago
- Never had one
- Not sure
- As soon as possible
See the lead your team receives
Routine Dental Cleaning 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 routine dental cleaning workflows
| Cliont capability | Routine Dental Cleaning application |
|---|---|
| Branching logic | Routes leads differently based on whether the cleaning is for the patient themselves, a child, or another adult they care for, so intake wording and next steps match who's actually being scheduled. |
| Automatic lead scoring | Weighs how overdue the patient is on cleanings together with how soon they want to be seen, so a 'never had one' patient wanting an ASAP slot surfaces above someone just exploring options. |
| Clinical flag surfacing | Marks a yes answer on current tooth or gum pain so front desk staff see it immediately, even though the visit was booked as a routine cleaning. |
| Free-text routing | Delivers whatever the patient types about what the dentist should know directly into the same lead record sent to your CRM, without a separate intake step. |
Common routine dental cleaning lead scenarios
Overdue patient with active pain
Someone who hasn't had a cleaning in over a year and reports tooth or gum pain wants an appointment as soon as possible; this combination scores highest and should reach the front desk immediately.
Parent scheduling for a child
A caregiver selects 'my child' and wants to book within a month with no reported pain, which needs a different scheduling and consent flow than an adult self-booking.
Recently seen patient just browsing
A patient who was cleaned within the last 6 months and marks 'just exploring options' still registers as a valid lead, but the timing answer signals lower booking urgency than someone marking ASAP.
Caregiver unsure of history
Someone booking for another adult they care for selects 'not sure' on last cleaning date and adds a free-text note about sensitivity, flagging a case that may need a phone follow-up before the visit is confirmed.
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
Routine Dental Cleaning lead-intake FAQs
How does the intake handle someone booking a cleaning for their child instead of themselves?
The first question asks who the cleaning is for, so a parent or guardian selecting 'my child' is captured distinctly from a self-booking or someone booking for another adult they care for, letting your front desk route it to the right scheduling and consent workflow.
Since every last-cleaning answer counts as high value, how do you separate urgent leads from casual ones?
The scoring weight all answers to 'when was the last cleaning done' carry meaningful value, but the separate question on how soon they'd like to schedule is what distinguishes an ASAP request from someone who's just exploring options.
What happens if a patient reports tooth or gum pain on what they booked as a routine cleaning?
A yes answer to the pain question is a clinical flag your team can review before confirming, since a patient in pain may need a different appointment type than a standard cleaning slot.
Why does 'never had one' or 'not sure' score as highly as 'over a year ago'?
All three responses to the last-cleaning question carry weight of 7 or higher because they signal a patient with unknown or overdue oral health status, which is exactly the kind of lead worth prioritizing over a recently-seen patient.
How is the free-text note used before the appointment?
Whatever a patient adds in the open field about what they'd like the dentist to know is delivered alongside the scored answers, so hygienists and dentists see context without needing a separate call to gather it.
Does this intake overlap with your Gum Disease Screening or New Patient Dental Exam pages?
No. This intake is built around the five routine-cleaning questions on relation, recency, pain, timing, and notes; Gum Disease Screening and New Patient Dental Exam use their own separate qualification catalogs for those distinct visit types.
Turn routine dental cleaning visitors into qualified patients
Give every routine dental cleaning visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.