TBI intake that captures diagnosis, cause, and liability up front
Prospective clients answer about diagnosed head trauma, ongoing symptoms, and financial losses, then upload medical records before their case reaches your CRM as a scored, ready-to-review lead.
The exact intake your traumatic brain injuries leads complete
This is the real 7-question guided intake for Traumatic Brain Injuries — the same flow your customers finish before you ever pick up the phone.
What a qualified traumatic brain injuries lead should tell you
A claim involving a diagnosed concussion or brain injury from an accident, where the intake needs to confirm the medical diagnosis, how the injury happened, whether a liable party exists, and what ongoing symptoms or financial losses resulted.
- Suffer Head Or Brain
- This Injury Happen Because
- Believe Someone Else (
- Injury Occur Within Last
- Had Ongoing Symptoms Or
- Had Financial Losses Because
- There Insurance Policy Or
The questions your team needs answered
Every traumatic brain injuries intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did you suffer a head or brain injury (such as a concussion or traumatic brain injury) that was diagnosed by a medical professional or treated at a hospital/clinic? | A professional diagnosis confirms objective medical documentation rather than a self-reported head bump, which is often the difference between a viable claim and none. |
| Did this injury happen because of an accident or incident (for example, a car crash, fall, assault, or unsafe property)? | Confirming an accident or incident caused the injury establishes it isn't a pre-existing or unrelated medical condition, which is foundational to any personal injury claim. |
| Do you believe someone else (a driver, business, property owner, employer, or another person) may be responsible for what happened? | This filters cases with a plausible liable party from those with no identifiable defendant, which is one of the strongest predictors of case viability. |
| Did the injury occur within the last 2 years? | Flags whether the injury falls inside or outside a typical filing window, which affects whether the case is worth pursuing at all. |
| Have you had ongoing symptoms or limitations since the injury (such as headaches, dizziness, memory or concentration problems, mood changes, sleep problems, or sensitivity to light/noise)? | Ongoing symptoms signal the severity and duration of damages, which shapes how much the case may ultimately be worth. |
| Have you had financial losses because of the injury (medical bills, time missed from work, reduced ability to work, or needing help at home)? | Documented financial losses quantify economic damages, giving early insight into settlement or case value before a consultation is booked. |
| Is there an insurance policy or company involved (auto insurance, homeowner/business insurance, workers’ comp, or another insurer)? | Confirms whether there's an insurance policy to pursue recovery against, which affects how a matter would realistically be resolved. |
How Cliont scores traumatic brain injuries leads
Every answer is weighted automatically — no manual review required.
Value signals
- Suffer Head Or Brain: yes
- This Injury Happen Because: yes
- Believe Someone Else (: yes
- Injury Occur Within Last: yes
- Had Ongoing Symptoms Or: yes
- Had Financial Losses Because: yes
Urgency signals
- This Injury Happen Because
See the lead your team receives
Traumatic Brain 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 traumatic brain injuries workflows
| Cliont capability | Traumatic Brain Injuries application |
|---|---|
| Weighted answer scoring | Diagnosed injury, clear liability, and recent injury date carry the top weights in this catalog, so a documented TBI with an identifiable at-fault party ranks well above a vague, undocumented head injury. |
| Document upload fields | Prospective clients attach hospital records or specialist diagnosis notes directly in the intake, so your staff has medical documentation before the consultation is even scheduled. |
| CRM routing rules | Leads that clear the diagnosis, liability, and injury-timing questions route straight into your CRM as qualified matters, while undiagnosed or non-accident cases can be handled separately. |
| Yes/no branching logic | A no answer on the accident-or-incident question signals the injury may be unrelated to any liable party, which the intake reflects immediately in the score rather than waiting for an attorney to ask. |
Common traumatic brain injuries lead scenarios
Clear diagnosis, clear fault
A rear-end crash victim with an ER-diagnosed concussion, ongoing memory issues, and a known at-fault driver triggers nearly every high-value signal in the catalog, so the intake routes this straight to CRM as top priority.
Old injury, statute risk
A prospective client with a hospital-diagnosed TBI from three years ago has strong liability and symptom answers, but the injury-timing question flags it as outside the typical filing window.
Head bump, no formal diagnosis
Someone reports a fall and head pain but never saw a doctor or went to the ER; without a professional diagnosis, the intake scores this well below documented cases.
Unsure who's at fault
A parking-lot fall with real symptoms and medical bills, but the prospective client isn't sure whether a property owner or another party is responsible, so the liability answer pulls the score down despite documented damages.
No accident, medical cause
Symptoms consistent with brain injury but no accident or incident behind them, such as a stroke or unrelated medical event, get caught early since there's no liable party tied to the case.
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
Traumatic Brain Injuries lead-intake FAQs
What happens when a lead never got an ER or doctor diagnosis for their head injury?
The intake still records their answer, but a no on the diagnosed-injury question pulls the score down significantly since undocumented brain injuries are harder to substantiate in a claim.
Does the intake flag cases that might be outside the statute of limitations?
Yes, the injury-timing question flags cases where the incident happened more than two years ago so your team can check filing deadlines before booking a consultation, though exact statutes vary by state and claim type.
Can prospective clients submit medical records or accident reports through the form?
The intake collects hospital discharge paperwork, specialist notes, and incident reports as uploads, so your team has documentation attached to the lead before the first call.
How does the score change if a prospective client isn't sure who's at fault?
The liability question carries one of the highest weights in the catalog, so a no or uncertain answer on who may be responsible noticeably lowers the score compared to a case with an identified at-fault party.
Does the intake account for lost wages and medical bills?
Yes, the financial-losses question captures whether the prospective client has incurred medical bills, missed work, or needed home help, and that factors into the overall score alongside the medical and liability answers.
What if the injury wasn't caused by an accident at all?
If the prospective client indicates their injury wasn't tied to any accident or incident, the intake reflects that with a much lower score, since there's no clear incident to build a personal injury claim around.
Turn traumatic brain injuries visitors into qualified cases
Give every traumatic brain injuries visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.