PFAS intake that captures diagnosis and water source up front
Ask about diagnosis type, water source history, and exposure location before you commit consultation time, then route qualified PFAS claims to your CRM with medical records attached.
The exact intake your pfas contamination leads complete
This is the real 7-question guided intake for PFAS Contamination — the same flow your customers finish before you ever pick up the phone.
What a qualified pfas contamination lead should tell you
Screens whether a prospective claimant has a recognized PFAS-linked diagnosis, a documented water source or exposure site, and treatment history sufficient to support a mass tort claim.
- Been Diagnosed With Health
- Use Water From Specific
- Know Where Possible Pfas
- Been Diagnosed With Kidney
- Diagnosis Happen Within Last
- Receive Medical Treatment Diagnosed
- Before Diagnosis, Did Live
The questions your team needs answered
Every pfas contamination intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Have you been diagnosed with a health condition after possible PFAS exposure in the United States? | A confirmed diagnosis is the baseline signal that separates a real claimant from someone still researching PFAS exposure. |
| Did you use water from a specific home, well, or local water system for at least 6 months before diagnosis? | A sustained water source tie is the single highest-weighted answer because it establishes a plausible exposure pathway a firm can investigate. |
| Do you know where the possible PFAS exposure happened? | Knowing the exposure site lets your team move directly into investigation instead of spending consultation time tracing the source. |
| Have you been diagnosed with kidney cancer, testicular cancer, thyroid disease, ulcerative colitis, or preeclampsia? | Naming one of the recognized PFAS-linked conditions carries more weight than a general diagnosis since these are the conditions litigation has centered on. |
| Did your diagnosis happen within the last 10 years? | A diagnosis within the last 10 years reduces the chance a claim runs into a limitations problem before your team even reviews it. |
| Did you receive medical treatment for your diagnosed condition after the diagnosis? | A "yes" flags a higher-value, higher-urgency lead you’ll want to reach first. |
| Before your diagnosis, did you live near a military base, airport, landfill, or chemical plant in the United States for at least 6 months? | Proximity to a base, airport, landfill, or chemical plant gives your team a fallback exposure signal when the claimant can't name a specific water source. |
How Cliont scores pfas contamination leads
Every answer is weighted automatically — no manual review required.
Value signals
- Been Diagnosed With Health: yes
- Use Water From Specific: yes
- Know Where Possible Pfas: yes
- Been Diagnosed With Kidney: yes
- Diagnosis Happen Within Last: yes
- Receive Medical Treatment Diagnosed: yes
Urgency signals
- Use Water From Specific
See the lead your team receives
PFAS Contamination Lead
From first click to qualified lead
Follow people and businesses seeking counsel 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 matter
Smart questions adapt to their matter and capture the full scope.
They share the documents
The facts, dates, and any paperwork come attached, so you can assess the matter before the consultation.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for pfas contamination workflows
| Cliont capability | PFAS Contamination application |
|---|---|
| Conditional question branching | Only shows the specific-condition question (kidney cancer, testicular cancer, thyroid disease, ulcerative colitis, preeclampsia) after a general diagnosis is confirmed, avoiding a long form for leads who answer no upfront. |
| Weighted scoring engine | Applies the highest weight to a six-month-plus water source history, so leads with that answer surface at the top of the queue even before your team opens the file. |
| Document upload capture | Collects medical diagnosis records and treatment documentation directly in the intake, so the claim arrives in your CRM with the evidence your team needs to make an initial call. |
| CRM routing | Sends leads that combine a qualifying diagnosis with a known water source or exposure location straight to your CRM as high-priority, while weaker combinations route as standard follow-ups. |
Common pfas contamination lead scenarios
Confirmed diagnosis, known well water
A recognized PFAS-linked condition plus 6+ months on a specific home or well water supply hits the intake's highest-value and urgency signals together.
Diagnosed but exposure site unclear
The claimant has a qualifying diagnosis but can't yet identify where the exposure happened, so the intake still flags value while surfacing the missing exposure-location detail for follow-up.
Old diagnosis, no ongoing treatment
A diagnosis outside the 10-year window with no documented treatment scores lower than a recent, actively-treated case, helping staff triage older inquiries differently.
Base or landfill proximity, no diagnosis yet
Someone lived near a military base or chemical plant but hasn't been diagnosed with any condition, so the intake captures the exposure context without treating it as a live claim.
Recent diagnosis, specific water system named
A claimant diagnosed within the last decade who names a specific local water system and describes ongoing medical treatment produces the strongest combination of intake answers.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book matters
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 mass torts intake templates
PFAS Contamination lead-intake FAQs
How does the intake tell a strong PFAS claim from a weak one?
It weighs whether the person has a qualifying diagnosis, whether they used a specific water source for at least six months, and whether they can identify the exposure site, so a diagnosed claimant with a named water source scores well above someone with vague symptoms and no source.
What happens if the lead doesn't know where they were exposed?
The intake still asks whether they lived near a military base, airport, landfill, or chemical plant for at least six months, which gives your team a secondary exposure signal even when the specific water source isn't identified yet.
Does the intake distinguish between the recognized PFAS conditions?
Yes, it asks directly whether the diagnosis is kidney cancer, testicular cancer, thyroid disease, ulcerative colitis, or preeclampsia, which are weighted higher than a general health-condition answer.
Why does diagnosis timing matter in the scoring?
Diagnoses within the last 10 years are weighted higher, since older diagnoses can raise limitations questions your team will want to review before a consultation is booked.
What documentation should the intake collect before a claim reaches my CRM?
It's built to gather medical records tied to the diagnosis and treatment, plus any documentation connecting the claimant to the water source or location they identify, before the lead is routed.
How is this different from the intake for Roundup or talcum powder claims?
PFAS intake is structured around water source and location history rather than product use, so it asks about home, well, or local water systems and nearby military bases or landfills instead of product exposure questions.
Turn pfas contamination visitors into qualified cases
Give every pfas contamination visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.