Foot and ankle intake that captures weight-bearing status up front
Patients tell you how the pain started, how long it has lasted, and whether they can bear weight before they ever reach your front desk. Photos of swelling, bruising, or deformity attach automatically, so your team can see which foot and ankle cases need attention this week.
The exact intake your foot and ankle pain leads complete
This is the real 7-question guided intake for Foot and Ankle Pain — the same flow your customers finish before you ever pick up the phone.
What a qualified foot and ankle pain lead should tell you
Orthopedic evaluation of foot or ankle pain, injury, or deformity, covering everything from an acute sprain to a chronic issue that has never been imaged or treated.
- Did Foot Or Ankle
- Unable Put Weight On
- Long Have Had This
- Noticed Visible Swelling, Bruising,
- Already Had Imaging, Such
- Tried Treatments Like Rest,
- Patient, Or Seeking Care
The questions your team needs answered
Every foot and ankle pain intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How did your foot or ankle pain begin? | Segments the lead so you can route, price, and prioritize it correctly. |
| Are you currently unable to put weight on the affected foot or ankle? | Inability to bear weight is a strong indicator of an acute injury needing faster scheduling rather than a routine consult. |
| How long have you had this pain? | How recently the pain started separates a fresh injury that needs prompt attention from a longstanding issue that can wait for a standard slot. |
| Have you noticed visible swelling, bruising, or deformity? | Visible swelling, bruising, or deformity often signals a more serious injury and prompts a photo upload for clinical review before scheduling. |
| Have you already had imaging, such as an X-ray or MRI, for this issue? | Knowing whether imaging already exists helps staff decide if the visit is a first evaluation or a follow-up on existing results. |
| Have you tried treatments like rest, bracing, or physical therapy for this issue? | Segments the lead so you can route, price, and prioritize it correctly. |
| Are you the patient, or are you seeking care on behalf of someone else? | Identifying a caregiver versus the patient ensures the clinical answers and contact information are attributed to the right person. |
How Cliont scores foot and ankle pain leads
Every answer is weighted automatically — no manual review required.
Value signals
- Unable Put Weight On: yes
- Less than 1 week
- 1 to 4 weeks
- 1 to 6 months
- More than 6 months
- Noticed Visible Swelling, Bruising,: yes
See the lead your team receives
Foot and Ankle Pain 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 foot and ankle pain workflows
| Cliont capability | Foot And Ankle Pain application |
|---|---|
| Conditional scoring logic | Weighs the weight-bearing answer, pain duration, and swelling or deformity together, so a fresh injury with visible deformity scores well above a months-old ache with none. |
| Photo upload widget | Triggers specifically when a patient reports visible swelling, bruising, or deformity, attaching the image directly to that answer for clinical review. |
| Treatment-history capture | Records the multi-select list of prior treatments tried, so referring notes on bracing, PT, or medication reach the CRM without a follow-up call. |
| Caregiver identification flag | Flags submissions where the person completing intake is a caregiver rather than the patient, so contact details and clinical answers stay correctly attributed. |
Common foot and ankle pain lead scenarios
Acute injury, can't bear weight
Sudden onset, pain under a week old, and an inability to put weight on the foot pushes this straight to the top of the queue alongside any swelling or deformity photos submitted.
Chronic pain, months old
A recurring issue lasting more than six months with prior bracing or physical therapy still tried scores lower on urgency but still routes cleanly for a standard evaluation.
Post-surgical recheck
Pain that started after a previous procedure with imaging already on file gives your team the treatment history before the patient walks in.
Caregiver booking for a parent
When the person filling out the intake is a caregiver rather than the patient, the answers still capture onset, duration, and weight-bearing status for the actual patient.
Swelling with no clear injury
Gradual onset paired with visible swelling or deformity but no reported injury flags a case worth reviewing before scheduling, even if the patient can still walk on it.
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 orthopedics intake templates
Foot and Ankle Pain lead-intake FAQs
How does the intake separate an urgent ankle injury from a routine chronic complaint?
The combination of how the pain began, how long it has lasted, whether the patient can currently bear weight, and whether there is visible swelling or deformity produces the priority signal, so a same-week sprain reads differently than pain present for months.
Does the form ask if the patient already has an X-ray or MRI?
Yes, the intake asks whether imaging has already been done for the issue, which lets your staff see if a referral or repeat imaging is likely needed before the visit.
What happens if someone is filling out the intake for a family member?
The intake asks directly whether the person completing it is the patient or a caregiver, so the clinical answers are attributed correctly and your team knows who to contact.
Can patients tell us what they've already tried, like bracing or physical therapy?
Yes, prior treatment attempts such as rest, bracing, physical therapy, or medication are captured as a multi-select field so your clinicians see what has already been ruled out.
How are swelling or deformity photos handled during intake?
When a patient reports visible swelling, bruising, or deformity, the intake prompts for a photo upload alongside that answer so your team can review the image before the appointment is confirmed.
Turn foot and ankle pain visitors into qualified patients
Give every foot and ankle pain visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.