Chronic sinus intake that asks what your team actually needs to know
Patients share how long they've had sinus symptoms, which symptoms they're experiencing, and any prior treatments like antibiotics or nasal sprays, plus a CT scan if they have one, so your front desk sees the full picture before booking.
The exact intake your chronic sinus problems leads complete
This is the real 6-question guided intake for Chronic Sinus Problems — the same flow your customers finish before you ever pick up the phone.
What a qualified chronic sinus problems lead should tell you
Ongoing or recurring sinus congestion, facial pressure, and related symptoms lasting weeks or months, typically requiring a history of duration, prior treatment, and any imaging before a specialist visit is scheduled.
- Long Have Been Experiencing
- Symptoms Experiencing
- Already Seen Doctor About
- Had Prior Treatments Such
- Symptoms Affecting Daily Activities
- Have Any Imaging Or
The questions your team needs answered
Every chronic sinus problems intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How long have you been experiencing sinus symptoms? | Longer or recurring symptom duration is the strongest signal that this is chronic rather than acute sinusitis, and it carries the heaviest weight in scoring. |
| Which symptoms are you currently experiencing? | Segments the lead so you can route, price, and prioritize it correctly. |
| Have you already seen a doctor about this sinus problem? | Knowing whether a primary care doctor or ENT has already seen the patient tells your team if this is a fresh case or a referral with existing history. |
| Have you had prior treatments such as antibiotics, nasal sprays, or sinus surgery? | Prior antibiotics, nasal sprays, or surgery indicate the patient has already exhausted standard treatments, which raises the value of a specialist visit. |
| Are your symptoms currently affecting your daily activities or sleep? | Symptoms disrupting sleep or daily activities are weighted highest among the yes/no answers, flagging patients with a more pressing quality-of-life impact. |
| Do you have any imaging or test results, such as a CT scan, related to this condition? | Existing CT scan or imaging results let your team gauge documented severity before the patient is ever seen in person. |
How Cliont scores chronic sinus problems leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 4 weeks
- 4 to 12 weeks
- More than 12 weeks
- Recurring episodes over months or years
- Antibiotics
- Nasal sprays or rinses
See the lead your team receives
Chronic Sinus Problems 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 chronic sinus problems workflows
| Cliont capability | Chronic Sinus Problems application |
|---|---|
| Weighted scoring engine | Scores rise with longer symptom duration and prior treatments like antibiotics, nasal sprays, or surgery, separating patients with an established sinus history from newer, milder cases. |
| Document upload capture | Collects CT scan images or reports directly at intake so referring history and imaging are attached to the lead before your team reviews it. |
| Conditional routing to CRM | Sends patients who have already tried treatment or have documented imaging into your CRM as higher-priority records rather than treating every enquiry the same. |
| Multi-select symptom capture | Records which combination of facial pressure, congestion, discharge, smell loss, headache, or cough the patient is experiencing, giving your team symptom detail before the appointment. |
Common chronic sinus problems lead scenarios
Years of recurring sinus episodes
Patient reports recurring episodes over months or years and has already tried nasal sprays or antibiotics without lasting relief, which the intake flags as a strong candidate for a specialist workup.
First-time patient, symptoms under 4 weeks
Symptoms have only been present for a few weeks and no prior doctor visit has occurred, so the intake captures this as an earlier-stage case that may resolve without escalation.
Already worked up by primary care
Patient has seen a primary care doctor, tried antibiotics, and has a CT scan on hand, giving your team a documented history to review before the first ENT appointment.
Symptoms disrupting sleep and work
Patient answers yes to symptoms interfering with daily activities or sleep, which the intake weights heavily so these cases surface as more urgent than mild, intermittent congestion.
Recurrence after prior sinus surgery
Patient reports a history of sinus surgery along with ongoing symptoms, a combination the intake treats differently than a patient with no surgical history.
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
Chronic Sinus Problems lead-intake FAQs
How does the intake tell chronic sinusitis apart from a short cold?
The symptom duration question separates patients with under 4 weeks of symptoms from those with 4 to 12 weeks, over 12 weeks, or recurring episodes over months or years, so your staff can see at a glance whether this looks like a short-term issue or a longer-standing pattern.
What if the patient hasn't seen any doctor yet for this?
The intake records whether the patient has already been seen by a primary care doctor, an ENT specialist, or neither, so your team knows whether this would be a first evaluation or a referral case.
Can patients submit a CT scan or imaging report through the intake?
Yes, the intake asks whether the patient has imaging or test results such as a CT scan, and you can require the file as an upload so it's attached to the lead before it reaches your CRM.
How much does prior treatment history affect the lead score?
Antibiotics, nasal sprays or rinses, and especially prior sinus surgery carry meaningful weight in the scoring, since patients who have already tried standard treatments without resolution tend to be stronger candidates for a specialist visit.
Does this intake also cover related conditions like tonsil or hearing problems?
No, this intake is built specifically for chronic sinus symptoms; Tonsil and Throat Problems, Hearing Loss, and the other ENT subservices each use their own dedicated qualification catalog.
What happens when symptoms are affecting sleep or daily life?
That yes/no question is weighted so a patient reporting disruption to daily activities or sleep scores higher than one whose symptoms are present but not currently interfering, helping your front desk prioritize outreach.
Turn chronic sinus problems visitors into qualified patients
Give every chronic sinus problems visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.