Rash evaluation intake that captures onset, location, and red-flag
Patients share how long the rash has been present, where it's located, and whether fever, swelling, or breathing trouble accompanies it, plus photos, so your team can see red flags before booking an appointment.
The exact intake your rash evaluation leads complete
This is the real 6-question guided intake for Rash Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified rash evaluation lead should tell you
A dermatology intake used to assess an unexplained skin rash by capturing how long it has been present, where it appears on the body, and whether any systemic symptoms accompany it, so staff can route the case before booking.
- Long Has Rash Been
- On Body Rash Located
- Rash Accompanied By Fever,
- Have Photos Showing Rash
- Started Any New Medications,
- This Evaluation
The questions your team needs answered
Every rash evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How long has the rash been present? | Rash duration distinguishes an acute onset that may need faster review from a chronic case suited to a standard follow-up. |
| Where on the body is the rash located? | Body location shows whether the patient needs a focused check or a full-body exam, particularly when the rash is widespread. |
| Is the rash accompanied by fever, swelling, or difficulty breathing? | A yes here carries the highest scoring weight and signals a possible emergency that should not be booked into a routine slot. |
| Do you have photos showing the rash? | Photos submitted ahead of the visit let clinicians gauge severity before the patient walks in. |
| Have you started any new medications, skincare products, or foods recently? | Recent new medications, products, or foods point toward a possible allergic or contact reaction that can change the recommended visit type. |
| Who is this evaluation for? | Knowing whether the patient, their child, or a dependent is affected changes consent requirements and which provider should see the case. |
How Cliont scores rash evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 2 days
- 3 to 14 days
- 2 to 8 weeks
- More than 8 weeks
- Rash Accompanied By Fever,: yes
See the lead your team receives
Rash 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 rash evaluation workflows
| Cliont capability | Rash Evaluation application |
|---|---|
| Conditional urgency flagging | Automatically flags cases where fever, swelling, or breathing difficulty is reported alongside the rash, so those leads can be reviewed ahead of routine bookings. |
| Photo upload capture | Collects rash photos at intake so staff can see the presentation before the patient arrives, rather than waiting for an in-person look. |
| Multi-select symptom mapping | Captures every body area marked in the intake so staff know upfront whether a rash is localized or widespread across the body. |
| Patient relationship field | Uses the 'who is this for' response to route child or dependent cases differently from self-reported adult rashes. |
Common rash evaluation lead scenarios
Rash with fever or swelling
Patient reports rash accompanied by fever, swelling, or breathing difficulty, which carries the highest weight in the catalog and should be flagged ahead of routine scheduling rather than booked into a standard slot.
Long-standing rash, no systemic symptoms
Rash has been present for more than 8 weeks with no fever or swelling reported, pointing toward a chronic case suited to a standard follow-up visit rather than an urgent one.
New medication or product trigger
Patient recently started a new medication, skincare product, or food and reports a widespread rash, suggesting a possible allergic or contact reaction that changes the likely visit type.
Parent booking for a child
The evaluation is for a child rather than the person filling out the intake, which affects consent handling and which provider or slot type is appropriate.
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
Rash Evaluation lead-intake FAQs
How does the intake identify a possible emergency rash?
The intake asks directly whether the rash is accompanied by fever, swelling, or difficulty breathing. A yes answer carries the highest weight in the scoring model, so those cases can be surfaced ahead of routine bookings instead of landing in a standard queue.
Can patients report a rash that covers more than one area of the body?
Yes. The body location question is multi-select, so patients can mark face, trunk, arms or legs, hands or feet, or widespread involvement in a single response, giving staff a clear picture before the visit.
Does the intake ask about possible triggers like new medications or skincare products?
Yes, patients are asked whether they've started any new medications, skincare products, or foods recently, which helps flag cases that may be allergic or contact reactions rather than an unrelated skin condition.
What happens if a patient doesn't have photos of the rash?
The intake asks whether photos are available. If not, the lead still comes through with the reported duration, location, and symptom details, though photo submission helps staff assess severity before the visit.
Can someone submit this intake on behalf of a child or another dependent?
Yes, the intake asks who the evaluation is for, distinguishing between the patient themselves, their child, or another dependent they care for, which matters for consent and scheduling.
How is this intake different from the eczema or psoriasis treatment intake?
Rash Evaluation is built for unexplained or newly appearing rashes and screens for onset, location, and systemic symptoms, whereas the Eczema Treatment and Psoriasis Treatment intakes assume a known chronic condition and focus on flare management instead.
Turn rash evaluation visitors into qualified patients
Give every rash evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.