Know which heart rhythm evaluation leads are worth appointment time
The intake asks whether a patient is experiencing palpitations or fainting, how often the symptoms occur, and how soon they want to be seen — while collecting prior ECG or Holter records so your team can triage before booking a slot.
The exact intake your heart rhythm evaluation leads complete
This is the real 5-question guided intake for Heart Rhythm Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified heart rhythm evaluation lead should tell you
A clinical review of irregular, fast, or skipped heartbeats — covering symptom pattern, fainting risk, and any existing ECG or Holter data — used to determine how quickly a patient needs to be seen and by whom.
- Experiencing Symptoms Like Palpitations,
- Ever Fainted Or Felt
- Often These Rhythm Symptoms
- Have Any Prior Heart
- Soon Be Seen This
The questions your team needs answered
Every heart rhythm evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Are you currently experiencing symptoms like palpitations, skipped beats, or a racing heart? | A yes answer confirms active rhythm symptoms rather than a past or hypothetical concern, which is the baseline signal for scoring the lead at all. |
| Have you ever fainted or felt like you might faint during these episodes? | Fainting or near-fainting during episodes carries the highest weight in the catalog because it points to a syncope risk that typically needs faster clinical attention. |
| How often do these rhythm symptoms occur? | Frequency distinguishes a patient having daily episodes from one with rare, occasional symptoms, which changes how quickly they likely need to be seen. |
| Do you have any prior heart tests, such as an ECG or Holter monitor, available to share? | Knowing whether prior ECG or Holter data already exists tells staff whether the visit needs to start with baseline testing or can go straight to reviewing existing results. |
| How soon are you looking to be seen for this evaluation? | The stated timeframe is weighted directly, so 'immediately' and 'this week' responses separate genuinely time-sensitive requests from patients still researching their options. |
How Cliont scores heart rhythm evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Experiencing Symptoms Like Palpitations,: yes
- Ever Fainted Or Felt: yes
- This week
- This month
Urgency signals
- Immediately
See the lead your team receives
Heart Rhythm Evaluation Lead
From first click to qualified lead
Follow patients and caregivers 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 visit
Smart questions adapt to their visit and capture the full scope.
They share details
Symptoms, history, and documents come attached before the visit.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for heart rhythm evaluation workflows
| Cliont capability | Heart Rhythm Evaluation application |
|---|---|
| Weighted answer scoring | The fainting question is weighted higher than the palpitations-only question, so patients at real syncope risk are ranked above those with symptoms alone. |
| File upload capture | Patients can attach existing ECG printouts or Holter monitor summaries during intake, giving your team prior data before the first visit. |
| Urgency-based routing | The 'how soon' timing question feeds directly into lead priority, separating 'immediately' and 'this week' responses from 'just exploring options' submissions. |
| CRM delivery | Scored rhythm evaluation submissions, including symptom frequency and uploaded test records, are sent to your CRM instead of sitting in a shared inbox. |
Common heart rhythm evaluation lead scenarios
Fainting during palpitation episodes
Patient reports racing-heart episodes accompanied by near-fainting and wants to be seen immediately — the intake surfaces this as a high-priority combination before any appointment is booked.
Daily symptoms, no prior testing
Frequent palpitations occurring daily but no ECG or Holter data on file yet, signaling a patient who needs baseline testing rather than a routine follow-up slot.
Existing Holter results to review
Patient already has a Holter monitor report and wants to discuss findings — the upload lets your team review data ahead of the visit instead of repeating tests.
Rare symptoms, just researching
Symptoms occur rarely and the patient selects 'just exploring options' for timing, indicating a lower-urgency inquiry that can be routed to a standard scheduling queue.
Weekly episodes, no fainting history
Moderate-frequency palpitations without fainting create a mid-range profile the intake distinguishes from both the urgent and exploratory ends of the scale.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book visits
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 cardiology intake templates
Heart Rhythm Evaluation lead-intake FAQs
How does the intake treat a patient who reports fainting during episodes?
A yes answer to the fainting question carries a higher weight than the palpitations question alone, so patients who report both symptoms are scored as higher priority before your team ever sees the request.
Can patients attach existing ECG or Holter monitor results?
Yes — the intake asks whether prior heart tests are available and lets the patient share them, so your team can review existing data instead of starting from a blank chart.
Does how often symptoms occur change the lead's score?
Symptom frequency is captured separately from the yes/no symptom questions, giving your team visibility into whether a case is daily, occasional, or rarely occurring alongside the fainting and urgency answers.
What happens if someone selects 'just exploring options' for timing?
That answer carries the lowest weight of the urgency choices, so those leads land differently than someone who selects 'immediately' or 'this week,' helping you avoid holding an urgent slot for a non-urgent inquiry.
How is this intake different from the Chest Pain Evaluation form?
This intake is built around rhythm-specific signals — palpitations, fainting, and prior ECG/Holter data — rather than pain-focused questions, so it stays specific to Heart Rhythm Evaluation rather than reusing a generic cardiology form.
Where do qualified rhythm evaluation leads end up?
Once scored, qualified patient submissions are sent to your CRM along with their symptom answers and any uploaded test records, so staff aren't booking appointments based on incomplete information.
Turn heart rhythm evaluation visitors into qualified patients
Give every heart rhythm evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.