Medication management intake that captures medication count and
Ask for current medication counts, established PCP status, and how soon the review is needed, then collect a current medication list before anyone touches the schedule.
The exact intake your medication management leads complete
This is the real 7-question guided intake for Medication Management — the same flow your customers finish before you ever pick up the phone.
What a qualified medication management lead should tell you
Primary care review of a patient's active prescriptions, dosages, and refill needs — covering routine check-ins, new prescription starts, and side-effect concerns, with a check on whether the requester has authority to discuss or change the regimen.
- This Medication Management Request
- Many Current Prescription Medications
- Main Reason This Medication
- Patient Have Established Primary
- Have Current List All
- Soon Patient This Medication
- Legally Authorized Make Medication
The questions your team needs answered
Every medication management intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this medication management request for? | Segments the lead so you can route, price, and prioritize it correctly. |
| How many current prescription medications does the patient take regularly? | A higher medication count signals more complex care coordination, so it carries more weight than a patient starting from one or two prescriptions. |
| What is the main reason for this medication management request? | Segments the lead so you can route, price, and prioritize it correctly. |
| Does the patient currently have an established primary care provider? | An established primary care relationship means existing records and history, making these leads faster to act on than a first-time patient. |
| Do you have a current list of all medications and dosages available to share? | Knowing whether a current medication list is ready tells staff whether they'll need to build the medication history from scratch during the visit. |
| How soon does the patient need this medication review? | The requested timeframe determines whether a lead should be treated as a same-week priority or a lower-urgency exploratory request. |
| Are you legally authorized to make medication decisions for this patient? | A 'No' here means the requester may not have the standing to make decisions for the patient, which should be resolved before any appointment is confirmed. |
How Cliont scores medication management leads
Every answer is weighted automatically — no manual review required.
Value signals
- 1-2 medications
- 3-5 medications
- 6 or more medications
- None yet, starting new medications
- Patient Have Established Primary: yes
- Within the next day or two
See the lead your team receives
Medication 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 medication management workflows
| Cliont capability | Medication Management application |
|---|---|
| Weighted scoring engine | Weighs medication count and established PCP status so patients on multiple medications or already in your care system surface as higher priority. |
| Authorization flagging | Flags leads where the requester answers 'No' to being legally authorized to make medication decisions for another adult, so staff review consent before booking. |
| Document collection | Prompts the patient to confirm whether a current medication list and dosages is available, so staff know before the visit whether they're missing key information. |
| Urgency-based routing | Routes 'within the next day or two' timeframe answers ahead of 'just exploring options' requests, so side-effect concerns don't sit in the same queue as routine check-ins. |
Common medication management lead scenarios
Polypharmacy review request
A patient on 6 or more medications with an established PCP wants a routine review — the intake captures both signals so this lead scores high and reaches the right staff quickly.
New prescription starting soon
A patient selects 'None yet, starting new medications' and 'Starting a new prescription' as the reason, flagging a different intake path than an ongoing refill review.
Same-week side-effect concern
A patient reports concerns about side effects and needs a review within the next day or two — the urgency answer moves this ahead of routine review requests.
Caregiver requesting on behalf of another adult
Someone selects 'Another adult I care for' and must confirm legal authorization to make medication decisions — a 'No' here changes how the lead should be handled before booking.
No established PCP, needs refill help
A patient without an established primary care provider asks for help organizing refills and schedule, a lower baseline weight than a patient already tied into ongoing care.
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 primary care intake templates
Medication Management lead-intake FAQs
How does the intake handle requests made on behalf of someone else?
The intake asks who the request is for and, when it's another adult, whether the requester is legally authorized to make medication decisions for that patient — a 'No' answer should be reviewed before any appointment is booked.
What makes a medication management lead score higher?
Higher medication counts and an established primary care relationship both carry more weight, since patients on more medications or already in your system typically need faster, more coordinated attention.
Does the intake collect a medication list before the appointment?
Yes — the intake asks whether the patient has a current list of medications and dosages available to share, so your staff know upfront whether they're starting from complete information or not.
Can the intake tell a routine review apart from a new prescription request?
Yes, the reason field distinguishes reviewing current medications, side-effect concerns, starting a new prescription, and refill/schedule organizing, so each type can be routed differently.
How is urgency captured for medication reviews?
Patients select a timeframe ranging from within the next day or two to just exploring options, which lets you prioritize faster reviews ahead of lower-urgency requests.
What happens if the requester isn't authorized to make decisions for the patient?
That answer carries a low weight, which surfaces the lead for a manual check before your team discusses or schedules anything for a patient the requester may not be authorized to act for.
Turn medication management visitors into qualified patients
Give every medication management visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.