Liver evaluation intake that asks what your care team needs to know
Patients share their symptoms, existing liver diagnosis history, and how soon they need to be seen, plus upload lab results or imaging reports, so your team can see clinical context before booking a slot the patient may not be eligible for.
Preview your liver condition evaluation intake
Explore 6 questions from the Liver Condition Evaluation template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified liver condition evaluation lead should tell you
A structured intake for patients seeking evaluation of a suspected or confirmed liver condition, covering presenting symptoms, prior diagnosis status, and whether recent labs or imaging are already on hand for the specialist to review.
- Symptoms Or Concerns Prompting
- Have Known History Liver-Related
- Have Recent Lab Results
- Soon Be Seen This
- Scheduling This Evaluation Yourself
- Under Care Any Doctor
The questions your team needs answered
Every liver condition evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What symptoms or concerns are prompting this evaluation? | The specific symptom combination selected (jaundice, swelling, fatigue, abnormal labs, or family history) tells staff which clinical thread to prepare for before the appointment. |
| Do you have a known history of a liver-related diagnosis, such as fatty liver, hepatitis, or cirrhosis? | The weighted answer distinguishes a confirmed diagnosis from a suspected one or no history at all, directly shaping how urgently the lead should be reviewed. |
| Do you have recent lab results or imaging reports available to share with a specialist? | Knowing whether labs or imaging already exist tells your team whether the first appointment can move straight to review or needs testing arranged first. |
| How soon are you hoping to be seen for this evaluation? | The requested timeframe helps scheduling staff decide how quickly to reach back out, independent of the clinical scoring. |
| Are you scheduling this evaluation for yourself or for someone else? | Whether the patient is scheduling for themselves or someone else changes who your staff should be communicating with about next steps. |
| Are you currently under the care of any doctor for this liver concern? | If the patient is already under another doctor's care for the same concern, your team can flag this as a coordination case rather than a fresh evaluation. |
How Cliont scores liver condition evaluation leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Yes, previously diagnosed
- Suspected but not confirmed
- No known history
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Liver Condition Evaluation 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 liver condition evaluation workflows
| Cliont capability | Liver Condition Evaluation application |
|---|---|
| Weighted single-choice scoring | The diagnosis-history question carries distinct weights for previously diagnosed, suspected, and no known history, letting confirmed liver disease cases surface above general-check requests. |
| Document upload widget | Patients can attach existing lab results or imaging reports directly in the intake, so your team isn't chasing down records after the fact. |
| Multi-select symptom capture | The symptom question lets patients flag multiple concerns at once, such as fatigue plus abnormal labs, giving your staff a fuller clinical picture than a single free-text field. |
| CRM lead routing | Completed liver evaluation intakes, with symptom, history, and upload details attached, land directly in your CRM so front-desk staff aren't manually re-entering patient answers. |
Example liver condition evaluation lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Confirmed diagnosis, worsening symptoms
A patient with a prior fatty liver or hepatitis diagnosis reports abdominal swelling and has recent labs ready to share. The intake flags the confirmed history at higher weight so this request stands out from a routine check-in.
Abnormal labs, no specialist yet
A patient marks 'suspected but not confirmed,' selects abnormal lab results as the driving concern, and is not currently under any doctor's care for the issue. This combination signals a real referral gap worth prompt review.
General check, no symptoms flagged
A patient with no known liver history selects 'no specific symptoms, seeking general check' and has no timeframe pressure. The intake captures this as a lower-signal request without needing extra follow-up questions.
Booking on behalf of a relative
Someone schedules the evaluation for a parent, citing family history of liver disease but no confirmed diagnosis and no labs yet on hand. The self/other question routes this differently than a self-referral with existing records.
Jaundice with unclear history
A patient reports yellowing of skin or eyes, has no known liver diagnosis, but wants to be seen within a few days. The symptom selection carries clinical weight even without a confirmed diagnosis behind it.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
Lawmatics, MyCase, Clio Manage and Clio Grow
Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
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 gastroenterology intake templates
Liver Condition Evaluation lead-intake FAQs
How does the intake treat patients who suspect a liver problem but haven't been diagnosed?
The diagnosis-history question separates 'previously diagnosed,' 'suspected but not confirmed,' and 'no known history' into different weighted tiers, so a suspected case doesn't get scored identically to a confirmed cirrhosis follow-up.
Can patients submit lab results or imaging before their first visit?
Yes, the intake asks directly whether the patient has recent labs or imaging available and lets them upload those documents alongside their responses, so your team has records to review before the appointment.
How do you tell apart a self-referral from a caregiver scheduling for someone else?
A dedicated question captures whether the evaluation is for the patient themselves or for someone else, which matters for consent, communication, and who your staff should follow up with.
What if the patient is already being treated by another doctor for this liver issue?
The intake asks whether the patient is currently under a doctor's care for the concern, which helps your team decide whether this is a new evaluation or a coordination-of-care conversation.
Does the intake distinguish between different liver-related symptoms?
Patients select from specific concerns like yellowing of skin or eyes, abdominal pain or swelling, persistent fatigue, abnormal labs, or family history, rather than a single generic 'liver problem' checkbox.
How is the requested timeframe used once a lead comes in?
The timeframe answer, whether within days, within weeks, or no specific timeframe, is passed through with the lead so scheduling staff can prioritize outreach without re-asking the patient.
Turn liver condition evaluation visitors into qualified patients
Give every liver condition evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.