Skin cancer screening intake that captures mole changes up front
Ask whether a mole has changed, capture family history of skin cancer, and confirm how soon the patient wants to be seen, then route lesion photos and full-body vs. specific-area details straight to your CRM.
The exact intake your skin cancer screening leads complete
This is the real 6-question guided intake for Skin Cancer Screening — the same flow your customers finish before you ever pick up the phone.
What a qualified skin cancer screening lead should tell you
A dermatology visit to examine a changing mole or spot, or perform a full-body check, in order to decide whether a lesion needs biopsy or further evaluation.
- Have Specific Spot Or
- This Visit Full-Body Skin
- Anyone In Immediate Family
- This Screening
- Soon Be Seen
- Had Skin Cancer Screening
The questions your team needs answered
Every skin cancer screening intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Do you have a specific spot or mole that has changed in size, shape, or color? | A yes answer signals a specific concerning lesion, which is the single strongest factor pushing this lead toward urgent review. |
| Is this visit for a full-body skin check or for one particular area of concern? | Knowing whether the visit is a full-body check or a single spot lets staff estimate the appointment length before it's booked. |
| Has anyone in your immediate family been diagnosed with skin cancer? | A yes answer adds hereditary risk context that keeps a lead in the higher-priority pool even without a currently changing mole. |
| Who is this screening for? | Identifying who the screening is for flags cases involving a child or dependent that may need separate consent handling. |
| How soon are you hoping to be seen? | The chosen timing option tells staff whether to slot the patient into the next available opening or standard scheduling. |
| Have you had a skin cancer screening with a dermatologist before? | Knowing whether this is the patient's first dermatologist screening helps the provider prepare relevant history questions ahead of the visit. |
How Cliont scores skin cancer screening leads
Every answer is weighted automatically — no manual review required.
Value signals
- Have Specific Spot Or: yes
- Anyone In Immediate Family: yes
- As soon as possible
- Within a few weeks
- Routine annual check
Urgency signals
- Anyone In Immediate Family
Disqualifiers
- Not sure yet
See the lead your team receives
Skin Cancer Screening 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 skin cancer screening workflows
| Cliont capability | Skin Cancer Screening application |
|---|---|
| Automated lead scoring | Combines the changed-mole answer, family history, and how-soon timing into a single priority score so urgent screenings surface ahead of routine annual checks. |
| Branching intake logic | Routes patients who select 'specific area of concern' down a shorter path than those requesting a full-body check, keeping the intake relevant to the visit type. |
| On-behalf-of capture | Records whether the screening is for the patient, a child, another family member, or someone they care for, so staff can confirm consent before booking. |
| Photo capture during intake | Lets patients attach images of the mole or lesion so providers can pre-review it before the appointment slot is confirmed. |
Common skin cancer screening lead scenarios
Urgent changing mole
A patient reports a mole that changed shape or color, wants to be seen as soon as possible, and has a family history of skin cancer, so the intake pushes this lead to the top of the queue.
Routine annual full-body check
A returning or new patient requests a full-body screening as a routine annual visit with no specific mole concern or family history, scoring as valid but lower urgency for standard scheduling.
Screening for a family member
A parent submits the intake on behalf of a child with a specific spot of concern, so staff can see who the visit is for and confirm consent before booking.
First-time patient, unsure timing
Someone who has never had a dermatologist skin check selects 'not sure yet' on timing and 'not sure' on full-body vs. specific area, and the intake still routes it as a new-patient screening rather than an urgent case.
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
Skin Cancer Screening lead-intake FAQs
How does the intake separate an urgent mole check from a routine annual screening?
It combines the answer about a changed mole or spot with the selected timing preference, so a 'yes' on the change question paired with 'as soon as possible' scores much higher than a routine annual request.
Can a patient submit this intake for someone else, like a child?
Yes, the intake asks who the screening is for, so staff can see upfront whether it's the patient, a child, another family member, or someone they care for before confirming the appointment.
Does the intake distinguish between a full-body exam and a check on one spot?
Yes, patients choose between a full-body check, a specific area of concern, or 'not sure,' which helps front-desk staff estimate the appointment length before it's booked.
Does family history of skin cancer affect how a lead is prioritized?
Yes, a family history of skin cancer is a weighted factor that keeps a lead in the higher-priority pool even if the patient hasn't noticed a specific changing mole.
What happens if a patient has never had a dermatologist skin check before?
The intake asks about prior screening history so your team has that context on file, even though it isn't a scoring factor for urgency on its own.
What photos or documents does the intake collect from patients?
Patients can attach photos of the mole or area of concern during intake, giving the provider something to review before the appointment is confirmed.
Turn skin cancer screening visitors into qualified patients
Give every skin cancer screening visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.