Newborn intake that flags fever and breathing concerns first
Ask about newborn age, the reason for the visit, and red-flag symptoms like fever or breathing trouble, then confirm guardian status and collect skin or jaundice photos before the appointment reaches your CRM.
The exact intake your newborn care leads complete
This is the real 5-question guided intake for Newborn Care — the same flow your customers finish before you ever pick up the phone.
What a qualified newborn care lead should tell you
Intake for infants from birth through the first months, screening for red-flag symptoms, feeding or growth concerns, and confirming who has legal authority to make care decisions before a visit is booked.
- Old Newborn
- Main Reason This Newborn
- Newborn Have Fever, Difficulty
- This Newborn Under Care
- Parent Or Legal Guardian
The questions your team needs answered
Every newborn care intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How old is the newborn? | Newborn age is weighted heavily because infants under 6 weeks generally need faster scheduling attention than older infants. |
| What is the main reason for this newborn care visit? | Segments the lead so you can route, price, and prioritize it correctly. |
| Does the newborn have a fever, difficulty breathing, or is unusually hard to wake? | A yes answer on fever, breathing trouble, or difficulty waking is the single highest-weighted signal, separating true urgent leads from routine bookings. |
| Is this newborn currently under the care of a pediatrician or clinic? | Whether the newborn already has a pediatrician tells staff if this is a new-patient inquiry or a continuity-of-care follow-up. |
| Are you the parent or legal guardian making care decisions for this newborn? | Confirming the submitter is the parent or legal guardian avoids booking a slot with someone who cannot consent to care decisions. |
How Cliont scores newborn care leads
Every answer is weighted automatically — no manual review required.
Value signals
- Under 2 weeks
- 2 to 6 weeks
- 6 weeks to 3 months
- Over 3 months
- Newborn Have Fever, Difficulty: yes
- Parent Or Legal Guardian: yes
See the lead your team receives
Newborn Care Lead — 9-Day-Old, Feeding Concern
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 newborn care workflows
| Cliont capability | Newborn Care application |
|---|---|
| Weighted scoring | Combines newborn age and the fever/breathing/hard-to-wake answer so the youngest, most symptomatic infants surface first. |
| Guided branching | Routes follow-up based on the selected visit reason, whether feeding, growth, jaundice, or sleep concern, without asking irrelevant questions. |
| Consent verification | Flags leads where the submitter is not the parent or legal guardian so staff confirm consent before confirming a slot. |
| Photo intake | Attaches skin or jaundice photos directly to the CRM record when that reason for visit is selected. |
Common newborn care lead scenarios
Under-2-week newborn with fever
A newborn under 2 weeks flagged with fever, breathing trouble, or difficulty waking scores at the top of the queue for immediate staff review rather than standard scheduling.
Feeding or weight concern, six weeks old
Parent selects feeding or growth concern as the visit reason for a 6-week-old with no red-flag symptoms, routing as a same-week rather than emergency appointment.
Jaundice question needs a photo
Caller selects jaundice or skin concern as the reason for visit, prompting the intake to request a photo so staff can assess severity before confirming a slot.
Grandparent submits the form
The person completing intake is not the parent or legal guardian, which lowers the guardian-status score and flags the lead for a callback to confirm consent before booking.
New patient with no pediatrician yet
A newborn with no existing pediatrician relationship answers routine checkup as the reason, distinguishing a new-patient inquiry from a continuity-of-care follow-up.
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
Newborn Care lead-intake FAQs
How does the intake handle a newborn with fever or breathing trouble?
The fever, breathing, or hard-to-wake question carries the highest weight in the catalog, so a yes answer pushes that lead to the top of your queue for a fast callback instead of sitting in standard booking order.
Does the intake treat a 3-day-old differently than a 3-month-old?
Yes, newborn age is asked directly and weighted so younger infants score higher, reflecting the tighter follow-up window newborn care typically requires.
What if someone other than the parent submits the form?
The guardian question flags submissions from anyone other than the parent or legal guardian with a lower score, so staff can confirm who has authority to consent before a slot is booked.
Do you ask whether the newborn already has a pediatrician?
Yes, the intake asks whether the newborn is currently under a pediatrician's care, which helps your team separate new-patient inquiries from existing-patient follow-ups.
What documentation do you collect for jaundice or skin concerns?
When jaundice or a skin concern is selected as the visit reason, the intake requests a photo so staff have visual context before scheduling.
How is this different from your well-child visit intake?
Newborn Care focuses on the first weeks of life and screens for feeding, growth, jaundice, and red-flag symptoms, while Well-Child Visit intake is built around routine periodic checkups later in infancy and childhood.
Turn newborn care visitors into qualified patients
Give every newborn care visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.