Cataract intake that captures real vision symptoms up front
Patients answer questions about their vision symptoms, prior cataract diagnosis, and how much daily activities are affected, then share their current prescription so your team sees the full picture before scheduling.
The exact intake your cataract evaluation leads complete
This is the real 5-question guided intake for Cataract Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified cataract evaluation lead should tell you
An intake that captures a patient's vision symptoms, prior cataract diagnosis status, and how much the change affects daily life so staff can judge whether a cataract evaluation appointment is warranted.
- Vision Symptoms Experiencing
- Eye Care Provider Previously
- Much Vision Changes Affecting
- Was Last Comprehensive Eye
- This Evaluation Yourself Or
The questions your team needs answered
Every cataract evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Which vision symptoms are you experiencing? | Symptoms like glare, halos, and yellowed colors carry the highest weights because they're more specific to cataracts than vague blurriness alone. |
| Has an eye care provider previously told you that you have cataracts? | A prior diagnosis from an eye care provider is a strong confirmation signal, weighted higher than a self-reported symptom check. |
| How much are your vision changes affecting your daily activities? | Daily impact tells staff how urgently the patient wants surgery or treatment discussed versus simply monitoring the condition. |
| When was your last comprehensive eye exam? | Knowing how recently the patient had an eye exam helps staff decide whether baseline records already exist or a fuller workup is needed. |
| Is this evaluation for yourself or for someone you are assisting? | Identifying whether the respondent is the patient or a caregiver prevents scheduling confusion and ensures the right person is confirmed at intake. |
How Cliont scores cataract evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Blurry or cloudy vision
- Glare or halos around lights
- Faded or yellowed colors
- Frequent glasses prescription changes
- Difficulty seeing at night
- Eye Care Provider Previously: yes
See the lead your team receives
Cataract 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 cataract evaluation workflows
| Cliont capability | Cataract Evaluation application |
|---|---|
| Weighted multi-select scoring | Each symptom in the vision symptoms checklist carries its own weight, so a patient reporting glare and halos scores differently than one reporting only glasses prescription changes. |
| Conditional routing | Responses marking the evaluation as being for someone the respondent is assisting can be flagged for staff to verify patient identity before scheduling. |
| Prior-diagnosis flag | The yes/no question about a prior cataract mention feeds directly into the lead score, surfacing patients already told they have cataracts. |
| CRM delivery | Only patients whose combined symptom, diagnosis, and daily-impact answers clear the qualification threshold are sent to your CRM as cataract evaluation leads. |
Common cataract evaluation lead scenarios
Classic cataract symptoms
Blurry vision, glare and halos, and a prior cataract mention from an eye doctor combine into a high-scoring lead ready for evaluation.
Mild or early changes
A patient reports minor impact and no prior diagnosis, giving staff a lower-priority lead that may still need a routine exam rather than a cataract slot.
Assisting a parent or spouse
The intake flags that someone is filling out the form on behalf of another person, so staff know to confirm the actual patient's details before booking.
No symptoms, just curious
A respondent selects no noticeable symptoms and no impact on daily activities, signaling the request may not need a cataract-specific appointment.
Overdue for any eye exam
A patient hasn't had a comprehensive eye exam in years and reports significant daily impact, which staff can treat as worth prioritizing even without a prior diagnosis.
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 ophthalmology intake templates
Cataract Evaluation lead-intake FAQs
How does this intake separate real cataract candidates from general vision complaints?
The symptom checklist weights glare, halos, faded colors, and frequent prescription changes higher than vague or absent symptoms, so patients with cataract-typical patterns score higher than someone who selects no noticeable symptoms.
What if the patient filling out the form isn't the one being evaluated?
The intake asks directly whether the evaluation is for the respondent or someone they're assisting, so front desk staff can confirm the actual patient's identity before confirming the appointment.
Does a prior cataract diagnosis change how the lead is scored?
Yes, patients who say a provider already told them they have cataracts score higher than those who answer no, since a prior diagnosis is a stronger signal for an evaluation appointment.
How is this different from your Comprehensive Eye Exam intake?
This intake focuses on cataract-specific symptoms like glare, halos, and yellowed colors, while the Comprehensive Eye Exam intake is built for general vision and health screening questions.
What happens with a lead that reports no symptoms and no daily impact?
Those answers score at the low end of the catalog's weighting, so staff can route the lead toward a routine exam rather than blocking a cataract evaluation slot.
Should urgent eye pain or sudden vision loss go through this intake instead?
No, sudden or painful eye issues are better suited to the Urgent Eye Problem intake; this form is built around gradual symptoms like cloudiness and glare.
Turn cataract evaluation visitors into qualified patients
Give every cataract evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.