Birth injury intake that flags provider error and ongoing care needs
Ask whether the injury happened during delivery, whether a provider may have made a mistake, and whether there are ongoing medical costs, then collect hospital records so only cases with real merit reach your CRM.
The exact intake your birth injuries leads complete
This is the real 7-question guided intake for Birth Injuries — the same flow your customers finish before you ever pick up the phone.
What a qualified birth injuries lead should tell you
Claims involving a serious, lasting injury to an infant or mother connected to pregnancy, labor, delivery, or the immediate postpartum period, typically raising a question of medical negligence by a hospital, doctor, or nurse.
- Injury Happen During Pregnancy,
- Baby Or Mother Have
- Injury Occur In United
- Believe Doctor, Nurse, Hospital,
- Know Name Hospital/Clinic Or
- Birth Injury Happen Within
- There Been Significant Medical
The questions your team needs answered
Every birth injuries intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did the injury happen during pregnancy, labor/delivery, or shortly after birth? | Confirming the injury happened during pregnancy, labor, delivery, or shortly after birth establishes this is actually a birth injury matter rather than a later pediatric issue. |
| Did the baby or the mother have a serious injury or lasting health problems as a result? | Lasting harm to the baby or mother is the core driver of case value in a birth injury claim, so this answer carries near-highest weight. |
| Did the injury occur in the United States or at a U.S. hospital/clinic? | A U.S. hospital or clinic setting is often required for a firm's jurisdiction, so a non-U.S. answer signals the case may not be a fit. |
| Do you believe a doctor, nurse, hospital, or clinic may have made a mistake or failed to act in time? | Suspected medical error is the negligence signal that separates a viable malpractice claim from an unfortunate but non-actionable outcome. |
| Do you know the name of the hospital/clinic or at least one medical provider involved? | Knowing the hospital or provider name lets a firm start verifying the claim immediately instead of chasing missing basic facts. |
| Did the birth injury happen within the last 10 years? | Birth injury claims carry statute-of-limitations pressure, so injuries within the last 10 years score higher for timely case viability. |
| Have there been significant medical bills, ongoing therapy/care needs, or loss of income related to the injury? | Documented medical bills, therapy needs, or lost income point to quantifiable damages that support the size of a potential claim. |
How Cliont scores birth injuries leads
Every answer is weighted automatically — no manual review required.
Value signals
- Injury Happen During Pregnancy,: yes
- Baby Or Mother Have: yes
- Injury Occur In United: yes
- Believe Doctor, Nurse, Hospital,: yes
- Know Name Hospital/Clinic Or: yes
- Birth Injury Happen Within: yes
See the lead your team receives
Birth 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 birth injuries workflows
| Cliont capability | Birth Injuries application |
|---|---|
| Weighted scoring engine | Scores rise when the injury happened during labor/delivery, at a U.S. facility, within the last 10 years, and involves a named provider with suspected error and lasting harm. |
| Guided branching logic | The intake can route the conversation toward provider name and hospital details once a family confirms suspected medical error, rather than asking every field up front. |
| Document capture | Collects hospital records, discharge summaries, and billing statements tied to ongoing therapy so a firm has documentation attached before the first call. |
| CRM routing | Sends qualified birth injury leads, with provider name and injury timeline attached, directly into the firm's CRM instead of a shared inbox. |
Common birth injuries lead scenarios
Clear delivery error, known hospital
The family names the hospital, suspects a delayed C-section or missed fetal distress signs, and the child has a lasting diagnosis. This combination of provider-error suspicion, identified provider, and lasting harm scores highest.
Injury confirmed, no suspected mistake
Parents describe a difficult delivery and a lasting health problem but aren't sure any provider did anything wrong. The intake still captures the case but the missing negligence signal keeps the score in the mid-range for review rather than automatic priority.
Older case near the time limit
The injury happened more than 10 years ago, which pulls the score down against the recency signal even if the harm was severe, prompting a firm to check statute-of-limitations viability before a consultation.
Full recovery, no lasting harm
A rough delivery occurred but the intake answers show no lasting injury to mother or baby, which drops the value signal tied to serious harm and routes the lead as lower priority rather than high value.
Injury outside the U.S.
The birth took place outside the United States or at a non-U.S. facility, which weakens the jurisdiction signal the intake relies on and flags the case for a jurisdiction check before booking a consultation.
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
Birth Injuries lead-intake FAQs
What happens if the family doesn't know which hospital or doctor was involved?
The intake still submits the lead, but not knowing a specific provider or facility lowers the score against that signal, since firms typically need a named provider to start investigating a birth injury claim.
Does the intake account for cases that happened outside the United States?
Yes, the intake asks whether the injury occurred at a U.S. hospital or clinic, and a non-U.S. answer weighs down the score since jurisdiction affects which firms can realistically take the case.
How does the intake handle the statute-of-limitations question?
One question asks whether the injury happened within the last 10 years. A no answer doesn't disqualify the lead outright, but it reduces the score so firms can decide whether the timeline still works before offering a consultation.
What if the parents aren't sure a medical mistake happened?
The intake asks directly whether the family believes a doctor, nurse, or hospital may have made a mistake or failed to act. A no or uncertain answer still gets captured, just weighted lower than a clear suspicion of error.
Can the intake capture ongoing therapy or medical costs for case value?
Yes, one question asks about significant medical bills, ongoing therapy or care needs, or lost income tied to the injury, which factors into the score alongside the severity of the harm.
Does a high score mean the case has been reviewed by a lawyer?
No, the score reflects how the intake answers line up with the catalog's weighted signals such as timing, provider error, and lasting harm. It flags which leads are worth a consultation, not a legal determination on the merits.
Turn birth injuries visitors into qualified cases
Give every birth injuries visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.