Know which deep cleaning leads are worth consultation time
Ask patients about gum disease history, current symptoms like bleeding or loose teeth, and how soon they want treatment, then collect photos of the gum line before anything lands in your CRM.
Preview your deep cleaning intake
Explore 5 questions from the Deep Cleaning template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified deep cleaning lead should tell you
A non-surgical periodontal procedure involving scaling and root planing below the gumline, used to treat gum disease, bleeding, and early bone loss identified during an exam.
- Dentist Told That Have
- Symptoms Experiencing
- Was Last Professional Dental
- Soon Schedule This Treatment
- Have Dentist Or Periodontist
The questions your team needs answered
Every deep cleaning intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Has a dentist told you that you have gum disease or bone loss around your teeth? | A prior diagnosis of gum disease or bone loss carries the heaviest weight in the catalog because it confirms clinical need rather than self-reported discomfort. |
| Which symptoms are you currently experiencing? | Loose teeth and gum pain carry the highest symptom weights, so selecting them pushes a lead toward high priority faster than bleeding or bad breath alone. |
| When was your last professional dental cleaning? | Knowing how long it has been since a professional cleaning helps distinguish overdue periodontal maintenance from a patient who was recently seen. |
| How soon are you looking to schedule this treatment? | Scheduling urgency ranges from 9 for as-soon-as-possible down to 2 for just exploring, directly separating leads worth chair time from casual inquiries. |
| Do you currently have a dentist or periodontist you see regularly? | Whether a patient already sees a periodontist regularly flags the lead as a referral follow-up or a new-patient acquisition opportunity, changing how staff should respond. |
How Cliont scores deep cleaning leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Dentist Told That Have: yes
- Bleeding gums
- Loose teeth
- Persistent bad breath
- Gum pain or swelling
- Receding gums
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Deep 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 deep cleaning workflows
| Cliont capability | Deep Cleaning application |
|---|---|
| Weighted scoring engine | Automatically applies the weight-9 signal from a prior gum disease or bone loss diagnosis so those leads route as high priority without staff reviewing every submission. |
| Multi-select symptom capture | Lets patients flag bleeding gums, loose teeth, or swelling individually, and weighs loose teeth (9) and gum pain (7) higher than bad breath alone when calculating the score. |
| Provider-relationship branching | Uses the answer about whether the patient already sees a periodontist to flag the lead as a referral follow-up versus a new-patient acquisition opportunity. |
| Urgency-based routing | Uses the scheduling timeline answer to push as-soon-as-possible requests ahead of just-exploring inquiries before either reaches your CRM. |
Example deep cleaning lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Diagnosed with bone loss, ready now
A patient already told by a dentist they have gum disease or bone loss, with loose teeth and wanting treatment as soon as possible, triggers the highest-weighted answers across the intake.
New patient with bleeding gums
No formal diagnosis yet, but bleeding gums flagged and no cleaning in over a year, this combination still scores meaningfully without an urgent timeline attached.
Existing patient overdue for cleaning
Someone who already sees a periodontist regularly but is 6 to 12 months past their last cleaning is a maintenance case, not a new-patient acquisition, and the intake surfaces that distinction.
Symptom-free routine inquiry
A patient selecting none of the listed symptoms and just exploring options scores lower on both fronts, helping staff avoid booking chair time for a casual inquiry.
Searching for a new provider urgently
Gum pain or swelling combined with no regular dentist and an as-soon-as-possible timeline flags a lead who needs both clinical attention and a new-patient workflow.
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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 periodontics intake templates
Deep Cleaning lead-intake FAQs
How does the intake separate severe gum disease cases from routine cleanings?
A prior diagnosis of gum disease or bone loss and symptoms like loose teeth or gum pain carry the heaviest weights in the catalog, so leads reporting them score well above someone with no symptoms who is just exploring options.
What happens if a patient has symptoms but was never formally diagnosed?
The symptom question is independent of the diagnosis question, so bleeding gums, receding gums, or persistent bad breath still contribute to the score even without a prior dentist diagnosis.
Can the intake tell if a lead already has a periodontist or is shopping for a new one?
Yes, patients are asked whether they currently see a dentist or periodontist regularly, are looking for a new provider, or have none, which helps your team distinguish a referral follow-up from a new-patient opportunity.
Does how soon a patient wants to be seen affect the score?
Yes, scheduling urgency runs from a weight of 9 for as soon as possible down to 2 for just exploring, so that answer alone can move a lead between priority bands.
What photos should patients upload during intake?
The intake collects a close-up photo of the gum line and any visibly loose or shifted teeth, giving your team something to look at before booking a consultation.
How is this different from the Gum Disease Treatment intake?
Deep Cleaning intake focuses on the initial non-surgical scaling and root planing entry point, while Gum Disease Treatment covers broader ongoing periodontal management, so the qualifying questions and scoring emphasis differ between the two.
Turn deep cleaning visitors into qualified patients
Give every deep cleaning visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.