First-visit intake that captures age, comfort level, and timing up
Ask about your child's age, comfort level with new places, and how soon they're hoping to schedule, plus a photo of any specific concern — then send ready-to-book families straight to your CRM.
The exact intake your first dental visit leads complete
This is the real 6-question guided intake for First Dental Visit — the same flow your customers finish before you ever pick up the phone.
What a qualified first dental visit lead should tell you
A child's introductory dental appointment focused on assessing early oral health, easing any anxiety about the visit, and setting the foundation for preventive care — the intake needs to establish age, prior dental history, and any specific concerns before chair time is reserved.
- Child'S Age
- Child Ever Been Dentist
- Have Any Specific Concerns
- Would Describe Child'S Comfort
- Soon Schedule This First
- Parent Or Legal Guardian
The questions your team needs answered
Every first dental visit intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is your child's age? | Age shapes how the visit should be run — an infant screening differs from a toddler's first cleaning attempt or an older child's delayed first checkup — so staff can plan the right chair-time approach. |
| Has your child ever been to a dentist before? | Knowing whether the child has ever seen a dentist before separates a genuine first visit from a family re-engaging with a new provider, which changes what paperwork and prep is needed. |
| Do you have any specific concerns about your child's teeth or gums right now? | A flagged concern signals the visit may need early triage rather than a purely preventive checkup, helping staff allot the right amount of time. |
| How would you describe your child's comfort level with new places and people? | Comfort level with new places tells staff whether to plan extra time or a gentler, sensory-aware approach before the child even arrives. |
| How soon are you hoping to schedule this first visit? | How soon the family wants to schedule is the clearest available signal for urgency, separating ready-to-book households from families still browsing. |
| Are you the parent or legal guardian who can consent to this appointment? | Confirming legal guardian consent prevents chair time from being reserved on a request that can't be authorized until an actual parent or guardian is looped in. |
How Cliont scores first dental visit leads
Every answer is weighted automatically — no manual review required.
Value signals
- Under 1 year
- 1 to 3 years
- 4 to 6 years
- 7 years or older
- This week
- This month
See the lead your team receives
First Dental Visit 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 first dental visit workflows
| Cliont capability | First Dental Visit application |
|---|---|
| Weighted lead scoring | Automatically ranks families asking to schedule this week or this month above those still exploring options, so front-desk staff call the ready-to-book families first. |
| Consent verification flag | Flags any submission where the person answering isn't the legal guardian, preventing chair time from being reserved on a request that can't yet be authorized. |
| Photo/video upload widget | Lets parents attach a picture of a specific dental concern so the dentist can glance at it before the visit rather than finding out cold at check-in. |
| Comfort-level tagging | Passes the child's anxiety level with new places into the CRM record so staff can prep a slower, sensory-friendly first appointment when needed. |
Common first dental visit lead scenarios
New patient, ready this week
A parent of a 1-to-3-year-old with no prior dental visits and no specific concerns wants an appointment this week, landing squarely in the highest-priority band for both age and timing.
Concern flagged, still exploring
A parent of a 7-plus-year-old notices something off but marks the timeline as 'just exploring options,' so the intake surfaces the concern for review while flagging lower urgency.
Anxious first-timer
The parent describes their child as very anxious about new places, giving staff a heads-up to plan a slower, sensory-friendly first visit before the family even arrives.
Non-guardian inquiry
A grandparent or caregiver submits the form and answers 'no' to being the legal guardian who can consent, which lowers the score until a parent confirms the appointment.
Returning family, new provider
The child has already been to a dentist before, but the family is scheduling this month for a fresh start with a new office, distinguishing this from a true first-ever visit.
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 pediatric dentistry intake templates
First Dental Visit lead-intake FAQs
How does the intake treat kids who've already seen a dentist before?
The intake asks directly whether the child has ever been to a dentist, so your team can tell a true first visit apart from a family switching providers and adjust the appointment prep accordingly.
What happens if someone other than a parent fills out the form?
The intake confirms whether the person submitting can legally consent to the appointment; a 'no' answer lowers the lead's score so staff can follow up with a parent before chair time is reserved.
Can the intake tell us if a child might be anxious before they arrive?
Yes — parents describe their child's comfort level with new places and people, which gets passed to your CRM so the front desk can plan extra time or a gentler approach for anxious kids.
Does the intake capture specific concerns before the visit?
Parents answer whether they have any specific concerns about their child's teeth or gums, and can attach a photo, so your team can review a possible issue before booking rather than discovering it in the chair.
How does the intake decide which first-visit leads are urgent?
Scheduling timeline is the strongest signal available — families wanting to book this week or this month score higher than those still 'just exploring,' so you can prioritize follow-up accordingly.
Does a child's age change how the lead is prioritized?
Age is captured for every submission, and while children from infancy through age six score similarly high, the intake still routes older first-time visitors to your CRM so no age group is filtered out.
Turn first dental visit visitors into qualified patients
Give every first dental visit visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.