Movement disorder intake that flags daily-activity impact up front
Patients tell you the movement symptom type, how long it's lasted, and whether it's affecting daily activities like eating or writing, plus any prior imaging or lab records — so you see the full picture before offering an appointment.
The exact intake your movement disorder evaluation leads complete
This is the real 6-question guided intake for Movement Disorder Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified movement disorder evaluation lead should tell you
A neurology intake used to triage new or ongoing movement symptoms — tremor, rigidity, involuntary jerks, or gait/balance problems — by capturing symptom type, duration, functional impact, and whether prior evaluation or imaging already exists.
- This Evaluation
- Movement Symptom Most Noticeable
- Long Has This Symptom
- Doctor Already Evaluated This
- Symptom Affecting Daily Activities
- Have Prior Imaging, Lab
The questions your team needs answered
Every movement disorder evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this evaluation for? | Knowing whether the submission is for the patient, a child, or someone under their care determines who needs to be contacted and what consent or guardianship context applies. |
| Which type of movement symptom is most noticeable? | The specific movement symptom type (tremor, stiffness, jerks, or balance) points toward different likely diagnoses and helps route the case to the right evaluation focus. |
| How long has this symptom been present? | Duration distinguishes a newly emerging symptom from a chronic, long-standing one, which changes how urgently the case should be reviewed. |
| Has a doctor already evaluated this symptom before? | Confirming whether another doctor has already evaluated the symptom tells you if this is a first-contact case or a second opinion requiring different preparation. |
| Is the symptom affecting daily activities such as eating, writing, or walking? | This is the highest-weighted question in the catalog, so a 'yes' on daily-activity impact is the clearest signal that the case is functionally significant and worth prioritizing. |
| Do you have prior imaging, lab results, or medical records related to this symptom? | Existing imaging or lab records let your team review prior workup before the appointment instead of ordering duplicate tests. |
How Cliont scores movement disorder evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Tremor or shaking
- Stiffness or slowness of movement
- Involuntary jerks or twitches
- Balance or walking difficulty
- Not sure
- A few days
See the lead your team receives
Movement Disorder 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 movement disorder evaluation workflows
| Cliont capability | Movement Disorder Evaluation application |
|---|---|
| Conditional branching | Routes the intake differently depending on whether the patient answers 'My child' versus 'Myself', so pediatric and adult movement cases collect the right context. |
| Weighted lead scoring | Uses the yes/no weighting on the daily-activity impact question (9 vs 6) to push functionally limiting cases higher than mild, early-stage symptoms. |
| Document and media upload | Lets patients attach prior imaging, lab results, or physician notes referenced in the intake so your team can review history before the appointment instead of during it. |
| CRM delivery | Sends the completed symptom-type, duration, and prior-evaluation profile straight into your CRM so staff aren't manually re-entering intake answers before booking. |
Common movement disorder evaluation lead scenarios
New tremor, no prior workup
A patient reports tremor that started days ago and hasn't been seen by any doctor yet — the intake flags this as a fresh, unworked case needing a full initial evaluation.
Long-standing gait problem with records
A caregiver submits on behalf of a parent with balance and walking difficulty present over a year, already evaluated elsewhere with prior imaging attached — routed as a case ready for a focused second opinion.
Child with involuntary jerks
A parent describes a few weeks of involuntary jerks or twitches in their child with no prior doctor visit and no records — a distinct pediatric pathway from adult tremor or stiffness cases.
Stiffness limiting daily function
A patient care provider reports several months of stiffness or slowness that's now interfering with eating and writing — the daily-activity answer signals a functionally significant case worth prioritizing.
Symptom type unclear
A referring family member isn't sure whether the movement is tremor, jerking, or balance-related — the intake still captures duration and daily impact so staff can triage even an ambiguous presentation.
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 neurology intake templates
Movement Disorder Evaluation lead-intake FAQs
How does the intake handle a patient who selects 'Not sure' for the symptom type?
That answer is scored the same as the other symptom categories, so the lead still reaches your CRM with duration and daily-impact context attached — your staff can clarify the symptom type at the appointment rather than losing the lead at intake.
Can the intake tell me whether a patient has already seen another doctor for this symptom?
Yes — the prior-evaluation question is a direct yes/no field, so you can see at a glance whether you're the first neurology contact or a second opinion before you schedule.
Does the form distinguish between a patient submitting for themselves versus a caregiver?
Yes, the first question captures whether the intake is for the patient themselves, a child, another family member, or a patient under someone's care, so your team knows who to contact and what consent context applies.
What happens if a patient has prior MRI or lab results?
The intake asks directly whether prior imaging, labs, or medical records exist for the symptom, letting your staff request those records ahead of the appointment instead of duplicating tests.
How is this different from your Seizure Evaluation or Neuropathy Evaluation intake?
Each subservice uses its own question set — this one is built around movement symptom type, duration, and functional impact, while Seizure Evaluation and Neuropathy Evaluation ask about their own condition-specific signals.
Will a mild, recently-started tremor still get flagged for review?
Yes — every symptom-type option carries a similar base weight, so a few-days-old tremor is still captured and scored, it just won't automatically outrank a case where daily activities are already affected.
Turn movement disorder evaluation visitors into qualified patients
Give every movement disorder evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.