Know which balance and dizziness leads are worth appointment time
Patients describe whether it's spinning, lightheadedness, or unsteadiness, note if they've fallen or have hearing changes, and can attach a symptom video or medication list so your team triages true vertigo before booking a slot.
The exact intake your balance and dizziness leads complete
This is the real 6-question guided intake for Balance and Dizziness — the same flow your customers finish before you ever pick up the phone.
What a qualified balance and dizziness lead should tell you
Intake for patients reporting vertigo, lightheadedness, or unsteadiness, capturing the sensation type, frequency, associated ear symptoms, fall history, and whether the episode has already been evaluated.
- Would Describe Main Sensation
- Often These Episodes Occur
- Also Have Hearing Changes,
- Fallen Or Nearly Fallen
- Had Any Recent Head
- Doctor Already Evaluated This
The questions your team needs answered
Every balance and dizziness intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How would you describe the main sensation you experience? | The type of sensation reported is the single strongest signal for whether this is likely vestibular vertigo versus a lower-weighted cause like lightheadedness. |
| How often do these episodes occur? | Segments the lead so you can route, price, and prioritize it correctly. |
| Do you also have hearing changes, ringing in the ears, or ear pressure? | Hearing changes, ringing, or ear pressure alongside dizziness raises the likelihood of an inner-ear condition worth prioritizing. |
| Have you fallen or nearly fallen because of these episodes? | A reported fall or near-fall indicates real physical risk and is weighted higher than episodes with no fall history. |
| Have you had any recent head injury, ear infection, or new medication before this started? | Recent head injury, ear infection, or new medication use can point to a specific trigger, helping staff anticipate what the visit will need to address. |
| Has a doctor already evaluated you for this issue? | Whether the patient has already been evaluated determines if they need a first workup or a more targeted follow-up, changing how the visit should be scheduled. |
How Cliont scores balance and dizziness leads
Every answer is weighted automatically — no manual review required.
Value signals
- Spinning or whirling sensation
- Lightheadedness or feeling faint
- Unsteadiness or trouble walking
- Other sensation
- Also Have Hearing Changes,: yes
- Fallen Or Nearly Fallen: yes
See the lead your team receives
Balance and Dizziness 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 balance and dizziness workflows
| Cliont capability | Balance And Dizziness application |
|---|---|
| Weighted scoring | Spinning sensations, falls, and hearing changes carry more weight than mild lightheadedness, so patients with likely inner-ear or Meniere's-pattern symptoms surface above vague, low-risk dizziness. |
| Branching logic | The multi-select on recent head injury, ear infection, or new medication lets the intake surface a plausible trigger without forcing every patient down the same follow-up path. |
| CRM routing | Patients who report a fall and haven't been evaluated yet can be routed into your CRM with enough context to prioritize scheduling ahead of stable, already-diagnosed follow-ups. |
| Structured lead fields | Evaluation status (not evaluated, evaluated without diagnosis, in treatment) is captured as its own field so staff can tell new workups apart from routine check-ins at a glance. |
Common balance and dizziness lead scenarios
Spinning vertigo with hearing changes
Patient reports a spinning sensation along with ringing or ear pressure and has not yet been evaluated, a combination the intake flags for a full inner-ear workup rather than a routine consult.
Fall risk from unsteadiness
Frequent, weekly unsteadiness plus a reported fall or near-fall pushes this lead to the top of the queue, since the catalog weights fall history heavily.
New medication, first episode
A lightheaded patient reporting a first-time episode tied to a recent medication change gets routed differently than recurring vertigo, since the cause may be pharmacological rather than vestibular.
Head injury with unclear diagnosis
Unsteadiness after a recent head injury, evaluated but without a clear diagnosis, surfaces as a distinct case that may need imaging or specialist follow-up rather than a standard balance workup.
Stable, already-treated dizziness
A patient with occasional episodes who already has a diagnosis and is in treatment scores lower priority, keeping routine follow-ups from crowding out unevaluated new cases.
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 ear nose and throat intake templates
Balance and Dizziness lead-intake FAQs
How does the intake separate true vertigo from general lightheadedness?
The intake asks patients to describe their main sensation directly, distinguishing spinning or whirling vertigo from lightheadedness, unsteadiness, or other sensations, since each points toward a different underlying cause.
Can the intake flag patients who have already fallen?
Yes, fall or near-fall history is a distinct question with its own weighting, so a patient reporting a fall is scored differently from one who has only felt off-balance.
What happens if the patient hasn't seen any doctor yet for this?
The intake asks whether they've already been evaluated, and unevaluated patients are weighted higher so your front desk can prioritize a first ENT assessment over a follow-up visit.
Does the intake check for hearing symptoms that might point to Meniere's disease?
It asks specifically whether the patient also has hearing changes, ringing, or ear pressure, since that combination alongside vertigo is clinically relevant and included in the catalog's higher-value signals.
Can it capture a recent medication change or infection that might explain the dizziness?
Yes, the intake asks about recent head injury, ear infection, and new medications as a multi-select, so your team can see potential triggers before the appointment.
How is this different from the Hearing Loss intake?
This intake centers on sensation type, falls, and balance-specific triggers, while the separate Hearing Loss subservice intake focuses on hearing decline itself; a patient with both symptoms would be routed based on which concern they lead with.
Turn balance and dizziness visitors into qualified patients
Give every balance and dizziness visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.