Know which mammography leads are worth appointment time
Patients share their reason for the exam, whether they have a doctor's referral, and how soon they need to be seen, plus upload prior mammogram reports for comparison, before a single slot is booked.
The exact intake your mammography leads complete
This is the real 6-question guided intake for Mammography — the same flow your customers finish before you ever pick up the phone.
What a qualified mammography lead should tell you
Breast X-ray screening or diagnostic exam used to detect or evaluate potential abnormalities in breast tissue, ordered for routine screening, symptom investigation, or follow-up on a prior finding.
- Main Reason Mammogram
- Have Doctor'S Order Or
- Had Mammogram Before
- Have Prior Mammogram Images
- Soon Schedule This Mammogram
- Have Breast Implants
The questions your team needs answered
Every mammography intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason you need a mammogram? | The reason for the exam separates a routine screening from a new lump or follow-up on an abnormal result, which drives how urgently the lead should be handled. |
| Do you have a doctor's order or referral for this mammogram? | Having a doctor's referral affects whether the exam can be booked as ordered or needs an order confirmed first, so staff can address it before the appointment. |
| Have you had a mammogram before? | Whether this is the patient's first mammogram helps staff plan extra time for patient education or history-taking at the visit. |
| Do you have prior mammogram images or reports to bring for comparison? | Availability of prior images or reports lets the radiologist plan a comparison read instead of discovering the gap at the appointment. |
| How soon are you looking to schedule this mammogram? | How soon the patient wants to be seen distinguishes a same-day clinical concern from a flexible screening request. |
| Do you currently have breast implants? | Breast implants change the imaging protocol, so staff can prepare the right views and appointment length in advance. |
How Cliont scores mammography leads
Every answer is weighted automatically — no manual review required.
Value signals
- Routine screening
- New symptom or lump found
- Follow-up on a prior abnormal result
- Family history concern
- Not sure
- Have Doctor'S Order Or: yes
See the lead your team receives
Mammography 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 mammography workflows
| Cliont capability | Mammography application |
|---|---|
| Automated lead scoring | Ranks leads reporting a new symptom or lump, or a follow-up on a prior abnormal result, above routine screening requests so clinically time-sensitive patients aren't buried in the queue. |
| Document upload capture | Collects the doctor's referral order and any prior mammogram reports or images directly during intake, so staff have what's needed for comparison before the visit. |
| Conditional branching | Surfaces the breast implants question so imaging protocol and appointment length can be adjusted for that patient ahead of scheduling. |
| CRM routing | Sends qualified mammography leads, tagged by reason for visit and scheduling urgency, into your CRM so front-desk staff can prioritize same-day requests over flexible ones. |
Common mammography lead scenarios
New lump found
A patient selects 'New symptom or lump found' and wants scheduling within a few days, which the intake flags as a higher-urgency clinical case rather than routine screening.
Follow-up on abnormal result
The patient is returning after a prior abnormal reading and confirms they have prior images to bring, which staff need for direct comparison at the exam.
Routine annual screening
A returning patient with no new symptoms selects routine screening and flexible timing, letting staff book this into standard availability without urgent handling.
No referral on file
The patient answers no to having a doctor's order, which the intake captures so staff can check insurance or order requirements before confirming the appointment.
Patient with breast implants
The patient confirms they have breast implants, a detail the intake surfaces so the imaging protocol and appointment length can be adjusted ahead of time.
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 diagnostic imaging intake templates
Mammography lead-intake FAQs
How does the intake handle patients who don't have a doctor's referral?
The intake still captures the lead when a patient answers no to having a referral, but it's scored lower than a referred exam so staff can follow up to confirm insurance or order requirements before scheduling.
Can the intake collect prior mammogram images or reports?
Yes, the intake asks whether the patient has prior mammogram images or reports for comparison and can collect them as an upload, so the radiologist has them ahead of the visit.
Does the intake flag patients with breast implants before they're booked?
Yes, the intake asks about breast implants directly, which lets staff prepare for implant displacement views or adjust the appointment slot instead of finding out at check-in.
How does the intake distinguish a routine screening from an urgent case?
The reason-for-visit question separates routine screening from a new symptom, lump, or abnormal follow-up, and the scheduling-timeframe question adds how soon the patient wants to be seen, so urgent cases surface ahead of routine ones.
What happens with first-time mammogram patients versus returning ones?
The intake asks whether the patient has had a mammogram before, which helps staff anticipate whether extra time for patient education or history-taking is needed at the appointment.
Is this intake specific to mammography or shared across imaging types?
This intake is built around the mammography catalog specifically; sibling exams like Ultrasound, MRI, and X-Ray each use their own qualification questions rather than a generic imaging form.
Turn mammography visitors into qualified patients
Give every mammography visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.