Amputation intake that captures fault and treatment up front
The intake asks whether someone else may be at fault, whether the incident happened within the last three years, and whether the client received medical treatment—then collects medical records before the lead ever reaches your CRM.
The exact intake your amputation injuries leads complete
This is the real 8-question guided intake for Amputation Injuries — the same flow your customers finish before you ever pick up the phone.
What a qualified amputation injuries lead should tell you
A claim arising from the loss of a limb, finger, toe, or other body part—by traumatic injury or required surgical removal—where the intake needs to establish that a third party may be at fault, that the incident happened in the US within the likely filing window, and that medical treatment and losses can be documented.
- Lose Limb, Finger, Toe,
- Amputation Happen Because Accident
- This Happen In United
- Incident Happen Within Last
- Someone Else ( Person,
- Identify Who May Be
- Receive Medical Treatment Injury
- Amputation Caused Major Losses
The questions your team needs answered
Every amputation injuries intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did you lose a limb, finger, toe, or another body part (or need surgical removal) because of an injury? | Confirms an actual limb, digit, or body part loss or surgical removal occurred, which is the core fact the case depends on. |
| Did the amputation happen because of an accident or incident (not a disease or a condition you were born with)? | Separates accident-caused amputations from disease or congenital cases, which typically fall outside a personal injury claim. |
| Did this happen in the United States? | Confirms the incident happened in the US, which matters for firms that only handle claims under US jurisdiction. |
| Did the incident happen within the last 3 years? | Flags whether the incident falls within a likely statute-of-limitations window that still allows the firm to act. |
| Was someone else (a person, company, or property owner) possibly at fault for what happened? | Establishes that a third party may be liable, since a case with no at-fault party has no one to pursue a claim against. |
| Can you identify who may be responsible (for example, a driver, employer, business, property owner, or product maker)? | Checks whether the client can actually name a driver, employer, business, or manufacturer responsible, which is needed to file a claim. |
| Did you receive medical treatment for the injury (such as emergency care, surgery, or follow-up care)? | Confirms documented medical treatment exists to support the injury and any resulting damages claim. |
| Has the amputation caused major losses like time off work, lost income, ongoing medical needs, or long-term limits? | Signals the size of damages, such as lost income or ongoing care, which drives how the firm values the case. |
How Cliont scores amputation injuries leads
Every answer is weighted automatically — no manual review required.
Value signals
- Lose Limb, Finger, Toe,: yes
- Amputation Happen Because Accident: yes
- This Happen In United: yes
- Incident Happen Within Last: yes
- Someone Else ( Person,: yes
- Identify Who May Be: yes
Urgency signals
- Receive Medical Treatment Injury
See the lead your team receives
Amputation Injury 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 amputation injuries workflows
| Cliont capability | Amputation Injuries application |
|---|---|
| Weighted answer scoring | Confirming an actual limb or digit loss, a clear at-fault party, and a recent US-based incident stacks the highest-weighted answers together, pushing genuine amputation cases into the High Priority band automatically. |
| Conditional flagging | An answer indicating the amputation resulted from disease rather than an accident routes the lead differently instead of treating it as a standard liability claim. |
| Document upload capture | Medical records and incident documentation are collected during intake so the case file in your CRM already reflects treatment and losses, not just a description of the injury. |
| Timing and jurisdiction checks | Answers on when the incident occurred and whether it happened in the US surface early, helping the firm spot statute-of-limitations or jurisdiction issues before a consultation is scheduled. |
| CRM routing | Leads that confirm a named at-fault party and documented medical treatment are sent through to the CRM as consultation-ready, while lower-scoring submissions can be held for manual review. |
Common amputation injuries lead scenarios
Industrial machinery amputation
A recent workplace incident with a clear employer or equipment maker at fault and documented emergency surgery scores toward High Priority, since fault, timing, and treatment all line up.
Injury from several years back
The intake flags cases where the incident happened more than three years ago, since that answer carries a lower weight and may signal a statute-of-limitations problem worth reviewing before booking a consultation.
Amputation from a medical condition
When the loss resulted from a disease or congenital condition rather than an accident, the intake captures that distinction early instead of routing the lead as a standard injury claim.
Incident occurred outside the US
A prospective client describing an accident that happened abroad answers differently on jurisdiction, which the intake surfaces so the firm can decide whether the matter fits its practice.
No identified at-fault party yet
Some callers know they lost a limb but haven't identified a driver, employer, or product maker responsible—the intake still records the injury and treatment details while flagging that liability isn't yet established.
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 personal injury intake templates
Amputation Injuries lead-intake FAQs
How does the intake tell an accident-related amputation apart from a medical one?
One question asks directly whether the amputation resulted from an accident or incident rather than a disease or condition present from birth, so cases outside personal injury liability are identified before a consultation is booked.
What happens if the amputation happened more than three years ago?
That answer carries a lower weight in scoring than a recent incident, which helps surface potential statute-of-limitations concerns for the attorney to review rather than assuming every submission is still actionable.
Does the intake check whether the incident happened in the United States?
Yes, jurisdiction is a direct yes/no question in the catalog, since a firm handling US personal injury claims typically needs the incident to have occurred domestically.
What if the person isn't sure who's responsible for the accident?
The intake separates two questions—whether someone else may be at fault, and whether the client can actually name who—so leads with a clear defendant score higher than ones where liability still needs investigation.
What documentation does the intake collect from amputation clients?
It's built to gather records tied to medical treatment and the incident itself, such as discharge summaries and reports, so the file arriving in your CRM already includes supporting documentation.
How is a lead scored if no medical treatment was received?
Medical treatment is one of the higher-weighted answers in the catalog, so a lead reporting no treatment for the amputation scores lower, since it may indicate the injury wasn't formally documented.
Turn amputation injuries visitors into qualified cases
Give every amputation injuries visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.