Medical malpractice intake that captures the alleged error up front
Ask prospective clients whether a diagnosis or treatment mistake caused new harm, when the care happened, and whether they know the provider's name — before a consultation gets booked. Cliont collects supporting records and sends only cases with real malpractice signals to your CRM.
The exact intake your medical malpractice leads complete
This is the real 8-question guided intake for Medical Malpractice — the same flow your customers finish before you ever pick up the phone.
What a qualified medical malpractice lead should tell you
A claim that a doctor, nurse, hospital, or other medical professional made an error — such as a wrong or delayed diagnosis, surgical mistake, medication error, or failure to treat — that caused a new injury or worsened an existing condition.
- Harm Happen In United
- Care Provided By Medical
- Believe Mistake In Medical
- This Mistake Cause New
- Injury Lead Significant Harm,
- Medical Care Or Injury
- Know Name Doctor, Nurse,
- Injured Person Or Close
The questions your team needs answered
Every medical malpractice intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did the harm happen in the United States? | Confirms U.S. jurisdiction, since most firms can't pursue a malpractice claim tied to care given abroad. |
| Was the care provided by a medical professional or facility (like a doctor, nurse, hospital, clinic, or dentist)? | Establishes that the care came from a licensed medical professional or facility, distinguishing malpractice from a general injury claim. |
| Do you believe a mistake in medical care happened (such as a wrong diagnosis, delayed diagnosis, surgery error, medication error, or failure to treat)? | Captures the core causation belief — a wrong diagnosis, surgical error, medication error, or failure to treat — that any malpractice case needs. |
| Did this mistake cause a new injury or make an existing condition significantly worse? | Links the alleged mistake to an actual new injury or worsened condition, which is required to have a viable claim rather than a complaint about care quality alone. |
| Did the injury lead to significant harm, such as additional medical treatment, lasting problems, disability, or death? | Measures damages severity, since additional treatment, lasting problems, disability, or death affect how much a case is worth pursuing. |
| Did the medical care or injury happen within the last 2 years? | Flags how close the claim is to a statute-of-limitations window based on how recently the care or injury occurred. |
| Do you know the name of the doctor, nurse, hospital, or clinic involved? | Knowing the provider or facility name speeds up records requests and early case investigation. |
| Are you the injured person or a close family member/legal representative who can act for them? | Confirms the person submitting has standing to act, whether as the injured patient or a qualifying family member or representative. |
How Cliont scores medical malpractice leads
Every answer is weighted automatically — no manual review required.
Value signals
- Harm Happen In United: yes
- Care Provided By Medical: yes
- Believe Mistake In Medical: yes
- This Mistake Cause New: yes
- Injury Lead Significant Harm,: yes
- Medical Care Or Injury: yes
See the lead your team receives
Medical Malpractice 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 medical malpractice workflows
| Cliont capability | Medical Malpractice application |
|---|---|
| Weighted lead scoring | Combines answers on the alleged medical error, resulting harm, and treatment timing so a surgical error with lasting injury outscores a vague or minor complaint. |
| Guided intake logic | Confirms the care was provided by a licensed medical professional or facility before treating a submission as a malpractice case rather than a general injury claim. |
| CRM routing | Sends only leads with a believable mistake, resulting harm, and U.S.-based care straight to your CRM instead of every visitor who mentions a bad medical outcome. |
| Document collection | Captures the provider's name and available records up front so intake staff aren't chasing down basic case details before the first consultation. |
Common medical malpractice lead scenarios
Recent surgical error, clear injury
A prospective client says a surgeon operated on the wrong site less than a year ago and it caused a new complication. Every high-value signal — mistake, causation, harm, and timing — lines up, so the intake routes this straight to the CRM as high priority.
Care received outside the U.S.
A caller describes a procedure performed while traveling abroad. The U.S.-jurisdiction question flags this early since most firms can't pursue claims tied to care given outside the country, and the lead scores accordingly.
Family reporting for a loved one
A daughter calls about her father's delayed cancer diagnosis. The representative question confirms she can act on his behalf, and the intake still captures the same error, harm, and timing detail as if he'd called himself.
Injury from years-old treatment
The alleged medication error happened over three years ago. The timing answer carries less weight than a recent claim, surfacing a lower score so the firm can judge statute-of-limitations exposure before offering a consultation.
Uncertain if a mistake occurred
A prospective client suspects something went wrong after a bad outcome but isn't sure it was preventable. How they answer the causation question shapes whether this becomes a case worth a callback.
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
Medical Malpractice lead-intake FAQs
How does the intake treat claims where the medical care happened more than two years ago?
It still captures the full picture, but the timing answer carries a lower weight than a recent claim, so older cases surface with a lower score rather than being silently dropped — useful in jurisdictions with longer statute-of-limitations windows.
What if a prospective client doesn't know the name of the doctor or hospital involved?
The intake still moves forward without that detail, but not knowing the provider lowers the score slightly since it can slow down records requests and case investigation.
Can someone submit an intake on behalf of an injured family member?
Yes — the intake directly asks whether the person submitting is the injured party or a close family member or legal representative acting for them, so a spouse, child, or guardian reporting a loved one's case is captured correctly.
What counts as a 'mistake' for this intake to flag as malpractice?
The intake asks broadly about wrong diagnosis, delayed diagnosis, surgery errors, medication errors, or failure to treat, so any of those answers count toward the causation signal without the client needing to name a specific legal theory.
Does the intake screen out care that happened outside the United States?
It asks directly whether the harm happened in the U.S., and a 'no' answer carries a much lower weight since most personal injury firms can't pursue malpractice claims tied to care given abroad.
How does the intake handle harm that turned out to be minor?
The significant-harm question carries far less weight when the answer is no, so cases without additional treatment, lasting problems, disability, or death naturally score lower than cases with clear ongoing damages.
Turn medical malpractice visitors into qualified cases
Give every medical malpractice visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.