Vision consult intake that flags surgery interest up front
Patients share their main vision concern, whether they already wear glasses or contacts, and how soon they want to be seen, plus upload their current prescription, so your team can spot surgery-ready consults before a slot is booked.
The exact intake your vision correction consultation leads complete
This is the real 5-question guided intake for Vision Correction Consultation — the same flow your customers finish before you ever pick up the phone.
What a qualified vision correction consultation lead should tell you
A consultation where a patient's vision concerns, current glasses/contact lens use, and exam history are reviewed to determine candidacy for correction options including surgery.
- Main Vision Concern Right
- Wear Glasses Or Contact
- Had Eye Exam In
- Soon Would Like Be
- Patient, Or Scheduling On
The questions your team needs answered
Every vision correction consultation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is your main vision concern right now? | Separates patients motivated by refractive surgery from routine checkups or sudden vision changes, which need different handling. |
| Do you currently wear glasses or contact lenses? | Knowing whether the patient already wears glasses or contacts gives staff a baseline before discussing correction options. |
| Have you had an eye exam in the past two years? | Recency of the last eye exam indicates how much existing diagnostic information is available before the consult. |
| How soon would you like to be seen? | Desired timing signals how quickly the patient expects to be scheduled, helping staff sequence bookings. |
| Are you the patient, or scheduling on behalf of someone else? | Whether the patient is booking for themselves or a dependent determines who the consult communication should be directed to. |
How Cliont scores vision correction consultation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Blurry distance or near vision
- Interested in surgery to reduce glasses/contacts use
- Routine vision checkup
- Sudden or recent change in vision
- Other
- As soon as possible
See the lead your team receives
Vision Correction Consultation 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 vision correction consultation workflows
| Cliont capability | Vision Correction Consultation application |
|---|---|
| Answer-based lead scoring | Patients who select 'interested in surgery' or 'as soon as possible' score differently than routine checkup or exploratory inquiries, so higher-intent consults surface first. |
| Conditional intake logic | When a lead indicates they're scheduling for a dependent rather than themselves, the intake can route follow-up communication to the correct contact. |
| Document upload | Patients can attach a current prescription or recent exam report before the visit, giving staff baseline data ahead of the consult. |
| CRM routing | Qualified vision consult leads, tagged with their stated concern and timing, are sent directly to your CRM instead of a shared inbox. |
Common vision correction consultation lead scenarios
Surgery-curious contact wearer
Patient picks 'interested in surgery' and wants to be seen as soon as possible while already in contacts — a strong candidate to prioritize for a consult slot.
Routine checkup, no urgency
Patient selects a routine vision checkup and is just exploring options, with no recent exam — useful for scheduling into standard availability rather than urgent slots.
Sudden change in vision
Patient reports a sudden or recent vision change and wants to be seen quickly, which the intake surfaces distinctly from routine or surgery-motivated visits.
Booking for a family member
Someone schedules on behalf of a dependent rather than themselves, which changes who the consult and any follow-up communication should be directed to.
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
Vision Correction Consultation lead-intake FAQs
Can the intake tell surgery-interested patients apart from routine checkups?
Yes. The main vision concern question separates patients exploring refractive surgery from those coming in for a routine checkup or a recent vision change, so your team can prioritize accordingly.
Does the intake capture whether the patient already wears glasses or contacts?
Yes, a direct yes/no question captures current glasses or contact lens use, which is relevant context before a correction consult is booked.
What happens when someone is scheduling for a family member instead of themselves?
The intake asks whether the person filling it out is the patient or scheduling for a dependent, so the consult and any follow-up go to the right contact.
Does the intake flag patients who haven't had a recent eye exam?
Yes, patients report whether they've had an exam in the past two years, giving your staff context on how much baseline information exists before the visit.
How does the intake capture how quickly a patient wants to be seen?
Patients choose from options ranging from as soon as possible to just exploring options, which helps your team sequence bookings against availability.
Is this intake only for patients considering surgery?
No. It covers the full range of vision correction inquiries, from routine checkups and sudden vision changes to surgery interest, without treating them as identical leads.
Turn vision correction consultation visitors into qualified patients
Give every vision correction consultation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.