Tooth filling intake that captures pain level and tooth count up front
Patients tell you how many teeth need work, whether a dentist already diagnosed the problem, and how urgently they want it treated, plus a photo of the affected tooth, so you can prioritize chair time before they ever call.
The exact intake your tooth filling leads complete
This is the real 6-question guided intake for Tooth Filling — the same flow your customers finish before you ever pick up the phone.
What a qualified tooth filling lead should tell you
A restorative procedure that repairs one or more decayed, cracked, or previously filled teeth, ranging from a single small cavity to several teeth needing simultaneous work.
- Filling Needed
- Experiencing Tooth Pain Or
- Many Teeth Believe Filling
- Dentist Already Told That
- Have Previous Filling That
- Soon Get This Treated
The questions your team needs answered
Every tooth filling intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is the filling needed for? | Knowing whether the filling is for the patient, their child, or another adult tells staff who to confirm scheduling and consent with before the visit. |
| Are you currently experiencing tooth pain or sensitivity? | Active pain or sensitivity carries a high weight because it signals the patient needs treatment sooner rather than a routine scheduling slot. |
| How many teeth do you believe need a filling? | The number of teeth involved helps staff estimate chair time and whether the case needs a longer appointment or multiple visits. |
| Has a dentist already told you that you need a filling? | A prior diagnosis from another dentist is one of the strongest confirmation signals in the catalog, indicating a real, already-identified need. |
| Do you have a previous filling that has cracked or fallen out? | A cracked or fallen-out prior filling flags a repair case, which may need different materials or urgency handling than a fresh cavity. |
| How soon are you looking to get this treated? | The weighted urgency tiers, from in-pain to just exploring, let the intake rank how quickly a lead should be offered an appointment slot. |
How Cliont scores tooth filling leads
Every answer is weighted automatically — no manual review required.
Value signals
- Experiencing Tooth Pain Or: yes
- Dentist Already Told That: yes
- As soon as possible, I'm in pain
- Within this week
- Within this month
- Just exploring options
See the lead your team receives
Tooth Filling 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 tooth filling workflows
| Cliont capability | Tooth Filling application |
|---|---|
| Weighted scoring engine | Combines the pain/sensitivity answer, prior diagnosis confirmation, and the four-tier urgency question to rank tooth filling leads by how soon chair time is actually needed. |
| Photo capture on intake | Collects a photo of the affected tooth alongside the tooth-count answer so your team can gauge case size before the patient arrives. |
| Dependent and caregiver routing | Uses the 'who is this for' question to flag leads submitted for a child or another adult, so front-desk staff confirm scheduling with the right person. |
| CRM delivery of qualified leads | Pushes diagnosis status, tooth count, and urgency tier directly into your CRM record so staff aren't re-asking basic triage questions on the phone. |
Common tooth filling lead scenarios
Patient in active pain
Answers yes to current pain or sensitivity and picks the 'as soon as possible' timeline, pushing the lead to the top of the queue for same-day or next-day chair time.
Already diagnosed elsewhere
A dentist has already told the patient they need a filling, so the intake treats this as a confirmed-need lead even if pain or urgency is lower, since the diagnosis weight alone carries strong signal.
Multiple teeth, unsure count
Patient selects 'more than three teeth' or 'not sure' for tooth count, flagging a case that likely needs a fuller exam and possibly longer or multi-visit chair time to plan for.
Old filling cracked or fell out
The patient reports a previous filling has failed, which the intake treats differently from a fresh cavity since repair cases often carry their own urgency and material history.
Parent booking for a child
The filling is needed for a child rather than the person filling out the form, which changes what the front desk needs to prep for the visit and who they should confirm the appointment with.
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
Tooth Filling lead-intake FAQs
What happens if a patient doesn't know how many teeth need filling?
The intake includes a 'not sure' option for tooth count, so those leads still get scored and routed to your CRM instead of being dropped for lacking a precise answer.
Does it matter if a dentist already diagnosed the cavity?
Yes. A prior diagnosis carries one of the highest weights in the catalog, so patients who've already been told by a dentist they need a filling are surfaced as high-value leads even without reported pain.
How does the intake tell a new cavity apart from a failed old filling?
A dedicated yes/no question asks whether a previous filling has cracked or fallen out, letting your team distinguish repair cases from fresh decay before the patient sits down.
Can someone submit an intake on behalf of a child or another adult?
Yes. The intake starts by asking who the filling is for, with options for self, a child, or another adult the patient cares for, so the right relationship context reaches your CRM.
How is urgency scored on a tooth filling lead?
Urgency is captured through a single question with weighted tiers, from 'as soon as possible, I'm in pain' down to 'just exploring options,' so you can see at a glance who needs chair time soonest.
Do low-urgency, exploratory leads still reach my CRM?
Yes. Even a patient who selects 'just exploring options' still submits a scored lead to your CRM, just with a lower priority weighting than someone in active pain or already diagnosed.
Turn tooth filling visitors into qualified patients
Give every tooth filling visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.