Know which ultrasound requests are worth an appointment slot
Patients tell you why they need the scan, which body area is involved, and whether they already have a provider referral, then upload prior imaging reports, so your team can screen out ineligible bookings before they hit the calendar.
The exact intake your ultrasound leads complete
This is the real 6-question guided intake for Ultrasound — the same flow your customers finish before you ever pick up the phone.
What a qualified ultrasound lead should tell you
An ultrasound exam uses sound waves to view organs, soft tissue, vascular structures, or a pregnancy, and the intake needs to capture the clinical reason, referral status, and body area before any slot is booked.
- Main Reason Ultrasound
- Have Written Order Or
- Soon This Ultrasound Performed
- Area Body Be Examined
- Have Any Prior Imaging
- This Ultrasound
The questions your team needs answered
Every ultrasound intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason you need an ultrasound? | The stated reason separates routine monitoring from follow-up on a finding, and both score higher than a not sure answer that needs clarification before scheduling. |
| Do you have a written order or referral from a healthcare provider for this ultrasound? | Whether a referral or order exists determines if staff can book directly or need to chase documentation first, which the answer weights reflect. |
| How soon do you need this ultrasound performed? | The requested timeframe tells staff which requests need a slot within days versus ones with no scheduling pressure. |
| Which area of the body needs to be examined? | The body area determines equipment setup and appointment length, so staff can assign the correct exam slot. |
| Do you have any prior imaging reports or images to share with the provider? | Confirming prior imaging exists lets staff request those files before the appointment so the provider isn't scanning without context. |
| Who is this ultrasound for? | Knowing whether the patient is booking for themselves, a child, or another family member affects who staff contact and what consent steps apply. |
How Cliont scores ultrasound leads
Every answer is weighted automatically — no manual review required.
Value signals
- Pregnancy monitoring
- Abdominal or pelvic symptoms
- Vascular or circulation concern
- Muscle, joint, or soft tissue concern
- Follow-up on previous finding
- Not sure
See the lead your team receives
Ultrasound 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 ultrasound workflows
| Cliont capability | Ultrasound application |
|---|---|
| Conditional branching | When a patient answers no to having a referral or order, the intake can flag the case for staff to collect one before any appointment slot is confirmed. |
| Weighted lead scoring | Reasons like follow-up on a previous finding and pregnancy monitoring carry higher weight than a not sure answer, so staff see which requests to prioritize first. |
| File upload capture | Patients can attach prior imaging reports or images directly in the intake so the reading provider has that context before the exam is scheduled. |
| Multi-party intake | When the ultrasound is for a child or another family member, the intake keeps the requester's contact separate from the patient details for scheduling and consent. |
Common ultrasound lead scenarios
Follow-up on a prior finding
The patient selects follow-up on a previous finding and confirms they have earlier imaging to upload, which scores as high value and flags the case for faster clinical review.
Pregnancy monitoring request
The reason is pregnancy monitoring and the body area is pregnancy-related, so the intake routes it as a standard obstetric scan rather than a diagnostic work-up for symptoms.
No referral on file
The patient answers no to having a written order or referral, which lowers the answer weight and tells staff to resolve the referral question before confirming a slot.
Unsure what's needed
The patient picks not sure for the reason and other area for the body part, so the lead still scores but is marked for a staff call to clarify the correct exam before scheduling.
Scan for a child or relative
The requester indicates the ultrasound is for their child or another family member, which changes who staff need to reach for intake follow-up and consent.
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
Ultrasound lead-intake FAQs
Does the intake check whether a patient has a referral before they book?
Yes, the intake asks directly whether the patient has a written order or referral, and answers weight the lead differently so staff can see who still needs one resolved before a slot is confirmed.
Can patients upload prior imaging as part of the ultrasound intake?
Yes, the intake asks whether the patient has prior imaging reports or images to share, and those files are collected alongside the reason for the exam so the reading provider has context up front.
How does the intake handle a vascular or circulation concern versus sending it to a separate Vascular Imaging service?
Vascular or circulation concern is one of the reason options within this ultrasound intake, so it stays in this flow unless your practice specifically directs vascular cases to a separate Vascular Imaging intake.
Does the intake capture how urgently a patient needs to be seen?
Yes, patients select a timeframe ranging from within a day or two to flexible with no set timeframe, so your team can distinguish faster requests from ones with no scheduling pressure.
What if the ultrasound is for the patient's child rather than themselves?
The intake asks who the ultrasound is for, including myself, my child, or another family member, so staff know who to contact and what consent process applies before booking.
Can the intake tell us which body area needs to be examined before the appointment?
Yes, patients select the area to be examined, such as abdomen, pelvis, pregnancy-related area, legs or arms, neck or thyroid, or other, which helps staff assign the right equipment and appointment length.
Turn ultrasound visitors into qualified patients
Give every ultrasound visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.