Behavioral concerns intake that asks what your team actually needs to
Ask about the child's age range, where the behaviors show up, and how long they've persisted, then collect any school documentation before the appointment gets booked. Cliont scores each entry so your team can prioritize the patients who need attention most.
The exact intake your behavioral concerns leads complete
This is the real 8-question guided intake for Behavioral Concerns — the same flow your customers finish before you ever pick up the phone.
What a qualified behavioral concerns lead should tell you
Pediatric intake for children showing behavioral, emotional, or social difficulties, capturing the child's age, which settings the behaviors appear in, how long they've persisted, and who is submitting the request on the child's behalf.
- Age Range Child
- Settings Show Behavioral Concerns
- Long Have These Behaviors
- Child'S School Or Daycare
- Child'S Parent Or Legal
- Child Previously Been Evaluated
- Soon Would Like Schedule
- Specific Behaviors Concern Most
The questions your team needs answered
Every behavioral concerns intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the age range of the child? | Age range determines which developmental and behavioral norms apply, helping staff prep age-appropriate assessment materials before the visit. |
| Which settings show the behavioral concerns? | Behaviors appearing across multiple settings often signal a broader clinical concern versus a single-context issue like a classroom-specific trigger. |
| How long have these behaviors been present? | Duration helps distinguish an ongoing concern from an acute, situational reaction that may resolve without intervention. |
| Has the child's school or daycare raised concerns about behavior? | An independent report from school staff corroborates the parent's concern and often signals a need for closer collaboration with the child's classroom. |
| Are you the child's parent or legal guardian? | Confirms the person booking has the authority to consent to care, preventing appointments booked by someone who can't authorize treatment. |
| Has the child previously been evaluated by a mental health or behavioral specialist? | Tells the clinician whether this is a first-time concern or a follow-up to existing specialist involvement, changing what records are needed at the visit. |
| How soon would you like to schedule an appointment? | Separates families wanting an urgent slot from those still exploring, so front-desk staff can prioritize calendar openings accordingly. |
| What specific behaviors concern you most? | Gives the clinician the parent's own words on the specific behaviors, which often surface details that structured options miss. |
How Cliont scores behavioral concerns leads
Every answer is weighted automatically — no manual review required.
Value signals
- Home only
- School only
- Multiple settings (home, school, elsewhere)
- Not sure
- Less than 1 month
- 1-6 months
See the lead your team receives
Behavioral Concerns 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 behavioral concerns workflows
| Cliont capability | Behavioral Concerns application |
|---|---|
| Multi-select answer scoring | Weighs whether behaviors appear in one setting or across home, school, and elsewhere, so multi-setting cases route ahead of single-setting reports. |
| Guardian verification field | Flags submissions where the person completing the form is not the parent or legal guardian, so staff can confirm consent before scheduling. |
| Free-text capture | Passes the parent's own description of the specific behaviors of concern straight to the clinician's notes, with no re-typing needed. |
| Document upload | Lets families attach school notes or prior evaluation records tied to the school-concern and prior-evaluation answers ahead of the visit. |
| Timeline scoring | Distinguishes recent-onset concerns from behaviors present for months, helping staff prioritize scheduling. |
Common behavioral concerns lead scenarios
School raises behavior concern
The daycare or school has already flagged the behavior and it shows up in multiple settings, a combination the intake weighs higher than a single-context report.
Guardian verifying booking eligibility
Someone other than the parent or legal guardian is filling out the form, so the intake flags the guardian-status answer before a slot gets booked for a child they can't consent for.
Recent, single-setting concern
A parent notices behaviors only at home over the past few weeks; the duration and setting answers keep this case lower in urgency than a multi-setting, longer-running pattern.
Ongoing case with prior evaluation
Behaviors have persisted over six months and the child has already seen a specialist, so the intake surfaces that history alongside any uploaded evaluation records.
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 pediatrics intake templates
Behavioral Concerns lead-intake FAQs
What happens if the person filling out the form isn't the child's parent or guardian?
The guardian-status question is weighted so staff can see immediately whether the submitter can legally consent to care, which matters before booking an appointment slot.
Can the intake tell us whether the behavior shows up at home, at school, or both?
Yes, the settings question is multi-select, so a report of behaviors across home, school, and elsewhere scores differently than a single-context report.
Does the form capture whether the school has already raised concerns?
It asks directly whether school or daycare staff flagged the behavior, giving your team independent corroboration alongside the parent's account.
How does the intake handle families who've already seen a behavioral specialist?
The prior-evaluation question lets returning families indicate existing specialist involvement, so your team knows to ask for those records rather than starting from scratch.
Is there room for parents to describe the specific behavior in their own words?
Yes, a free-text field captures the behaviors the parent is most concerned about, in addition to the structured questions on age, setting, and duration.
How is this different from the intake for developmental concerns?
Behavioral Concerns focuses on conduct, emotional, or social difficulties and their setting and duration, while the Developmental Concerns intake in the same pediatrics library centers on milestone and skill-based questions.
Turn behavioral concerns visitors into qualified patients
Give every behavioral concerns visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.