Acne intake that captures severity, history, and timeline
Patients tell you the acne severity, any scarring or dark marks, and how soon they want to start before they ever reach your calendar, with photos attached for review.
The exact intake your acne treatment leads complete
This is the real 5-question guided intake for Acne Treatment — the same flow your customers finish before you ever pick up the phone.
What a qualified acne treatment lead should tell you
Intake for patients seeking evaluation and treatment of active acne, covering severity, scarring, and prior treatment history so the practice can plan the right visit type.
- This Acne Treatment
- Would Describe Severity Acne
- Noticed Any Scarring Or
- Tried Any Treatments This
- Soon Would Like Start
The questions your team needs answered
Every acne treatment intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this acne treatment for? | Distinguishes self-bookings from minor or dependent cases that may need consent handling before scheduling. |
| How would you describe the severity of the acne? | Self-reported severity is the main driver of expected visit complexity and treatment planning. |
| Have you noticed any scarring or dark marks left by the acne? | Flags patients who may need scar-focused treatment options alongside standard acne care. |
| Have you tried any treatments for this acne before? | Shows whether a patient is starting fresh, has failed OTC options, or needs a prescription review or adjustment. |
| How soon would you like to start treatment? | Separates patients wanting to start immediately from those still exploring, guiding how quickly staff should follow up. |
How Cliont scores acne treatment leads
Every answer is weighted automatically — no manual review required.
Value signals
- Mild, occasional breakouts
- Moderate, persistent breakouts
- Not sure
- Noticed Any Scarring Or: yes
- As soon as possible
- Within a few weeks
Urgency signals
- Severe or widespread breakouts
See the lead your team receives
Acne Treatment 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 acne treatment workflows
| Cliont capability | Acne Treatment application |
|---|---|
| Branching intake logic | The 'who is this for' question routes minor and dependent bookings differently from self-bookings, flagging enquiries that may need consent handling before scheduling. |
| Weighted lead scoring | Severity, scarring, and start-timeline answers each carry their own weight, so a severe case wanting to start immediately scores distinctly higher than a mild, exploratory enquiry. |
| Photo capture at intake | Patients upload images of the affected areas so the clinical team can review distribution and scarring visually before the appointment is confirmed. |
| CRM handoff with context | Treatment history (OTC, prescription, or currently on a plan) travels with the lead into the CRM, so staff know what's already been tried without asking again. |
Common acne treatment lead scenarios
Severe breakout wanting fast start
Patient selects severe or widespread breakouts and wants to start as soon as possible, so the intake flags a time-sensitive lead for prompt scheduling.
Parent booking for a minor
The intake identifies the patient as a dependent minor, letting the front desk route the enquiry to appropriate consent and scheduling steps before booking.
Mild acne, just exploring
Someone with mild, occasional breakouts and no urgency yet still submits a full intake, giving staff context to follow up without treating it as time-sensitive.
Prior prescription history, visible scarring
A returning-type patient reports having tried prescription treatment before and confirms scarring or dark marks, signaling a case that likely needs more than a standard consult.
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 dermatology intake templates
Acne Treatment lead-intake FAQs
How does the intake capture acne severity without a clinician present?
Patients self-report severity as mild, moderate, severe, or not sure. All four responses carry meaningful weight, so the score reflects that even a 'not sure' answer is still a legitimate lead worth a look, not a filtered-out one.
Does the intake handle bookings made by a parent for a child?
Yes, the first question asks whether the treatment is for the patient themselves, their minor child, or another dependent, so staff can see at a glance whether the enquiry needs parental consent handling before the appointment is confirmed.
Are scarring and active breakouts treated as separate concerns?
The intake asks about scarring or dark marks as its own yes/no question, separate from severity, so a patient with mild active acne but noticeable scarring is still surfaced accurately rather than scored purely on breakout severity.
Does prior treatment history change how a lead is scored?
The intake records whether the patient has tried nothing, over-the-counter products, prescription treatment, or is currently on a plan, giving staff context on what's already failed before they reach out.
What photos does the intake ask patients to upload?
Patients are prompted to share recent photos of the affected areas so the clinical team has visual context on breakout distribution and any scarring before the first appointment.
How is urgency reflected if a patient wants to start treatment quickly?
The intake asks how soon the patient wants to start, and 'as soon as possible' is weighted highest among the timing options, so those enquiries stand out from patients who are just exploring options.
Turn acne treatment visitors into qualified patients
Give every acne treatment visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.