Know which eczema treatment leads are worth appointment time
Cliont's eczema intake captures symptom severity, affected body areas, and how soon the patient wants to be seen, along with skin photos, so your team can review each case before booking.
Preview your eczema treatment intake
Explore 7 questions from the Eczema Treatment template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified eczema treatment lead should tell you
Intake for patients seeking eczema evaluation or treatment, covering prior diagnosis status, current symptom severity, affected body areas, treatments already tried, and how soon they want to be seen.
- This Eczema Treatment
- Doctor Previously Diagnosed This
- Would Describe Current Severity
- Areas Body Affected By
- Already Tried Any Treatments
- Soon Be Seen This
- Have Photos Affected Skin
The questions your team needs answered
Every eczema treatment intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this eczema treatment for? | Identifying whether the treatment is for the patient, a child, or another family member lets staff route pediatric cases differently from adult self-referrals. |
| Has a doctor previously diagnosed this skin condition as eczema? | A confirmed prior diagnosis carries a higher weight than an unconfirmed one, since it changes whether the visit is treatment follow-up or initial evaluation. |
| How would you describe the current severity of the skin symptoms? | Severity carries the widest weight range in the catalog, directly separating mild dryness inquiries from severe, widespread cases. |
| Which areas of the body are affected by the skin symptoms? | Segments the lead so you can route, price, and prioritize it correctly. |
| Have you already tried any treatments for this condition? | Knowing whether the patient has already tried OTC products or prescriptions shows whether the next step is likely a first-line or escalated treatment. |
| How soon are you looking to be seen for this condition? | The requested timeframe is weighted from 'just exploring' to 'as soon as possible,' turning stated urgency into a direct scoring input. |
| Do you have photos of the affected skin that you could share with a provider? | Knowing whether photos are already available tells staff if a visual assessment can happen before the appointment or needs to be requested first. |
How Cliont scores eczema treatment leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Doctor Previously Diagnosed This: yes
- Mild, occasional dryness or itching
- Moderate, visible patches with regular discomfort
- Not sure
- As soon as possible
- Within this week
Urgency signals
- Severe, widespread or very painful areas
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Eczema 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 eczema treatment workflows
| Cliont capability | Eczema Treatment application |
|---|---|
| Weighted lead scoring | Combines prior-diagnosis status, symptom severity, and requested timing so a severe, undiagnosed flare-up scores differently than a mild, already-treated case. |
| Answer-based routing | Flags leads submitted on behalf of a child separately from self-referrals so pediatric eczema cases reach the right provider. |
| Photo availability capture | Records whether the patient has skin photos ready to share, letting staff request images before the visit rather than at check-in. |
| CRM delivery | Sends affected-area and treatment-history details straight to your CRM instead of leaving them in a form submission email. |
Example eczema treatment lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Severe flare, wants care fast
An adult reports severe, widespread symptoms and selects 'as soon as possible' for timing, giving the lead a high combined severity and urgency score.
Parent seeking care for child
The intake captures 'My child' as the patient and moderate severity, so front-desk staff can route pediatric eczema cases separately from adult self-referrals.
Already on prescription, seeking follow-up
A patient who selects 'prescription medication' under treatments tried is flagged as an existing-treatment case rather than a new diagnosis, changing how the visit should be framed.
Unsure if it's eczema at all
A patient who hasn't been previously diagnosed and picks 'Not sure' for severity is still scored and routed, but flagged for a diagnostic evaluation rather than a treatment-focused slot.
Widespread symptoms, no photos yet
A lead reporting symptoms across multiple body areas but answering 'no' to having photos available is flagged so staff know to request images before the visit.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
Lawmatics, MyCase, Clio Manage and Clio Grow
Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
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
Eczema Treatment lead-intake FAQs
How does the intake handle patients who aren't sure if what they have is eczema?
The severity question includes a 'Not sure' option with its own weight, so the lead is still scored and passed through instead of being dropped, and it's visible to staff as an unconfirmed diagnosis.
Can the intake tell if a lead is for a child rather than the person filling it out?
Yes, the first question asks who the treatment is for and captures 'My child' or 'another family member' separately from self-referrals, so pediatric cases can be routed correctly.
What if a patient hasn't tried any treatment yet?
The treatment-history question captures 'No treatments tried yet' alongside options for over-the-counter creams, prescriptions, or multiple approaches, giving you visibility into prior care before the appointment.
Do patients have to upload photos before booking?
The intake asks whether the patient has photos of the affected skin available to share; it's a yes/no signal rather than a mandatory upload, but it flags cases where visual context is missing.
Does this intake separate urgent flare-ups from routine check-ins?
Yes, the how-soon question ranges from 'as soon as possible' to 'just exploring options,' and each answer carries its own weight so urgent flare-ups score higher than casual inquiries.
How is this different from the intake for psoriasis or rash evaluation?
This catalog specifically asks whether a doctor previously diagnosed eczema and what treatments have already been tried for it, details that are more specific to managing eczema flare-ups than the psoriasis or general rash-evaluation intakes.
Turn eczema treatment visitors into qualified patients
Give every eczema treatment visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.