PFAS intake that captures exposure source and diagnosis up front
Ask about the water source, diagnosis, and financial losses before you offer a consultation, and require medical records to confirm the condition and timeline.
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
Claims involving a diagnosed health condition potentially linked to PFAS ('forever chemicals') exposure through a specific water source, typically requiring a matched diagnosis, known exposure location, and documented losses.
- Seeking Help Own (Or
- Regularly Drink, Cook With,
- Know Location (City/State And
- Been Diagnosed By Medical
- Diagnosis (Or First Time
- Have Out- -Pocket Losses
- Potential Claim Already Fully
The questions your team needs answered
Every pfas contamination intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Are you seeking help for your own (or a family member’s) health problems that you believe may be linked to PFAS (“forever chemicals”) exposure in the United States? | Confirms the inquiry is actually about a personal health claim rather than a general question about PFAS contamination. |
| Did you regularly drink, cook with, or bathe in water from a specific place (like a home well or a town water system) for at least 6 months before the health problem started? | A specific water source used for at least 6 months establishes the sustained exposure needed to link the condition to that site. |
| Do you know the location (city/state and address or nearby area) where the PFAS exposure likely happened? | A known location lets your team trace the case to known contamination sites and litigation groups already underway. |
| Have you been diagnosed by a medical professional with at least one of these: kidney cancer, testicular cancer, thyroid disease, ulcerative colitis, high cholesterol, or pregnancy-related high blood pressure/preeclampsia? | Matching one of the recognized diagnoses is the strongest single indicator of whether this claim fits current PFAS litigation criteria. |
| Did the diagnosis (or the first time you were told you had the condition) happen within the last 10 years? | A diagnosis within the last 10 years keeps the claim inside a realistic timeframe for causation and statute considerations. |
| Did you have out-of-pocket losses or major impacts because of the condition (such as medical bills, missed work, ongoing treatment, or lasting symptoms)? | Documented medical bills, missed work, or lasting symptoms show measurable damages rather than just a diagnosis on paper. |
| Is your potential claim already fully settled, released, or dismissed in court? | A settled or dismissed claim means there is likely nothing left to pursue, so this answer flags leads not worth consultation time. |
How Cliont scores pfas contamination leads
Every answer is weighted automatically — no manual review required.
Value signals
- Seeking Help Own (Or: yes
- Regularly Drink, Cook With,: yes
- Know Location (City/State And: yes
- Been Diagnosed By Medical: yes
- Diagnosis (Or First Time: yes
- Have Out- -Pocket Losses: yes
Urgency signals
- Regularly Drink, Cook With,
Lower-fit signals
- Potential Claim Already Fully: no
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 |
|---|---|
| Weighted scoring logic | Automatically weighs a matching diagnosis, exposure duration, and known location higher than a self-reported PFAS concern with no medical confirmation. |
| Disqualifying-answer routing | Flags leads who report their claim is already settled or dismissed so your firm doesn't schedule a consultation on a closed matter. |
| Structured document capture | Collects medical records and water-source documentation upfront so intake staff aren't chasing diagnosis confirmation after the call. |
| CRM handoff | Sends only leads with a documented diagnosis, known exposure site, and reported losses to your CRM, filtering out incomplete PFAS inquiries. |
Common pfas contamination lead scenarios
Confirmed diagnosis and known water source
Caller has a qualifying diagnosis within the last 10 years, drank from a known contaminated source for 6+ months, and documents out-of-pocket losses — the intake flags this as a strong claim.
Long-term well water, unclear diagnosis
Household used private well water for years but the caller's condition isn't one of the listed qualifying diagnoses, so the intake routes it as lower priority pending medical review.
Unknown exposure location
Caller believes their illness is PFAS-related but can't identify a specific water source or address, which lowers the score since exposure location is a key qualifying field.
Claim already settled or dismissed
The intake asks directly whether a related claim has already been settled or dismissed, and a yes answer signals lower fit regardless of the diagnosis.
Recent diagnosis, no documented losses
Caller has a qualifying diagnosis inside the 10-year window but reports no medical bills, missed work, or ongoing treatment, which the intake weighs as reduced value versus a case with documented damages.
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Notify your team
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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
PFAS Contamination lead-intake FAQs
How does the intake decide if a caller's diagnosis fits PFAS litigation?
The intake checks whether the caller has been diagnosed with one of the specific conditions in the catalog — kidney cancer, testicular cancer, thyroid disease, ulcerative colitis, high cholesterol, or pregnancy-related preeclampsia — and when that diagnosis occurred, since only conditions within the 10-year window carry higher weight.
What happens if a caller doesn't know exactly where the exposure occurred?
Not knowing the exposure location doesn't remove the lead, but it does lower the score since a known city/state or address is one of the higher-weighted qualifying fields your team needs to trace the water source.
Does the intake screen out people whose case is already settled?
Yes — the intake directly asks whether a related claim has already been settled, released, or dismissed, and answering yes to that question is treated as a lower-fit signal.
What if the caller had short-term exposure, like a few weeks at a rental?
The intake specifically asks whether water use lasted at least 6 months at a known location, so shorter or one-off exposure periods won't meet the threshold weighted as urgent in scoring.
What documentation should clients upload before their consultation?
Ask for medical records confirming the diagnosis, any water testing or utility records tied to the exposure address, and documentation of financial losses such as medical bills or missed-work records.
How is out-of-pocket loss weighted differently from diagnosis alone?
A qualifying diagnosis alone raises the score, but the intake also asks about medical bills, missed work, or ongoing treatment separately, since documented financial impact adds weight independent of the diagnosis itself.
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.