Turn chronic condition enquiries into appointment-ready leads
Ask patients which condition they're managing, whether they currently have a provider treating it, and how well controlled things are right now — then have Cliont request a medication list and send qualified patients straight into your CRM.
Preview your chronic condition management intake
Explore 5 questions from the Chronic Condition Management template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified chronic condition management lead should tell you
Ongoing support for patients managing a long-term condition such as diabetes, hypertension, asthma/COPD, heart disease, or thyroid disorder, where the intake needs to establish which condition, how well it's currently controlled, and whether the patient already has a provider managing it.
- Chronic Condition Help Managing
- Without Primary Care Provider
- Would Describe Condition'S Control
- This Care Being Arranged
- Soon Schedule Care
The questions your team needs answered
Every chronic condition management intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Which chronic condition do you need help managing? | Identifying which condition the patient needs help with lets you route the lead to the right clinician or care pathway before the appointment is booked. |
| Are you currently without a primary care provider actively managing this condition? | Patients without a provider currently managing their condition represent the biggest care gap, so this answer is weighted highest and drives urgency. |
| How would you describe your condition's control recently? | A poorly controlled answer signals the condition needs sooner attention than a well-controlled one, directly shaping how the lead is prioritized. |
| Who is this care being arranged for? | Knowing whether the requester is the patient, a family member, or a professional caregiver ensures the CRM record has the right contact for follow-up. |
| How soon are you looking to schedule care? | A 'within a few days' answer is the strongest timing signal in the catalog and should surface the lead ahead of others with no specific timeframe. |
How Cliont scores chronic condition management leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Without Primary Care Provider: yes
- Well controlled
- Somewhat controlled
- Poorly controlled
- Not sure
- Within a few days
Urgency signals
- Without Primary Care Provider
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Chronic Condition Management 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 chronic condition management workflows
| Cliont capability | Chronic Condition Management application |
|---|---|
| Answer-weighted scoring | Patients who report having no provider actively managing their condition are automatically scored higher since that answer carries the top weight in the catalog. |
| Priority queue routing | Leads who select 'within a few days' for scheduling are flagged for faster follow-up alongside poorly-controlled condition answers. |
| Condition-based segmentation | The single-choice condition question lets you tag each CRM record by diabetes, hypertension, asthma/COPD, heart disease, or thyroid disorder for easier caseload review. |
| Caregiver-aware intake fields | When the requester selects 'a family member' or 'a patient I care for professionally,' the intake captures that distinction so the CRM record shows who to actually contact. |
Example chronic condition management lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Newly diagnosed, no current provider
A patient managing high blood pressure or diabetes flags that they have no provider actively treating the condition, which the intake weights as the strongest urgency signal for faster follow-up.
Poorly controlled, wants care soon
A patient reports their condition is poorly controlled and wants to schedule within a few days — the two highest-weighted answers in the catalog, pushing this lead to the top of the queue.
Family member arranging care
Someone fills out the intake on behalf of a parent or spouse rather than themselves, which the intake captures separately so the right contact person is attached to the CRM record.
Stable patient, routine check-in
A patient with a well-controlled thyroid disorder and no specific timeframe still completes the intake, letting your team see this is a lower-urgency, routine follow-up rather than an active problem.
Connect Cliont to your workflow
Connect your CRM
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Lawmatics, MyCase, Clio Manage and Clio Grow
Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
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 primary care intake templates
Chronic Condition Management lead-intake FAQs
How does the intake identify patients without an existing provider for their condition?
The intake directly asks whether the patient is currently without a primary care provider actively managing the condition, and this answer carries the highest weight in the scoring model since it signals a care gap that needs faster attention.
Can the intake tell which chronic condition a patient is dealing with?
Yes, patients select from diabetes, high blood pressure, asthma or COPD, heart disease, thyroid disorder, or another condition, so your team can route the lead to the right clinician or care pathway before the appointment.
What happens if a patient isn't sure how well controlled their condition is?
That's a distinct answer option in the intake, weighted between the well-controlled and poorly-controlled responses, so it still surfaces as a lead worth reviewing rather than being treated the same as a stable, well-managed case.
Does the intake distinguish between a patient scheduling for themselves and a caregiver scheduling for someone else?
Yes, the intake asks who the care is being arranged for — the patient, a family member, or a patient the requester cares for professionally — so your team knows who to contact and who the actual patient is.
How is scheduling urgency captured for chronic condition leads?
Patients select whether they want care within a few days, within a few weeks, or have no specific timeframe, and the within-a-few-days answer is one of the strongest signals feeding the lead's overall score.
How is this different from the intake used for Medication Management?
This intake is built around condition type, control level, and provider status to decide if a chronic-care appointment is warranted, while the Medication Management intake focuses on prescription-specific questions — they're separate catalogs for separate visit types.
Turn chronic condition management visitors into qualified patients
Give every chronic condition management visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.