New patient visit intake that captures visit reason and insurance
Every new patient signup captures why they're booking, whether they carry current insurance, and any medications they take, so your front desk knows before the visit whether this person is ready to be scheduled or needs a quick eligibility check first.
The exact intake your new patient visit leads complete
This is the real 6-question guided intake for New Patient Visit — the same flow your customers finish before you ever pick up the phone.
What a qualified new patient visit lead should tell you
A patient's first appointment with a new primary care provider to establish ongoing care, capturing why they're being seen (wellness exam, ongoing condition, new symptom, medication refill, or referral follow-up), current insurance status, and any regular medications before the visit is confirmed.
- Seeking Establish Ongoing Care
- Main Reason Scheduling This
- Soon Be Seen
- Have Current Health Insurance
- Take Any Regular Prescription
- This Visit Being Scheduled
The questions your team needs answered
Every new patient visit intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Are you seeking to establish ongoing care with a new primary care provider? | The nine-point gap between yes and no reflects that a patient actively seeking an ongoing provider relationship is a far stronger new-patient fit than someone looking for a single, isolated visit. |
| What is the main reason for scheduling this visit? | Reasons tied to managing a condition or a new symptom carry the top weight because they signal clinical need that justifies a full new-patient slot rather than a brief administrative visit. |
| How soon are you hoping to be seen? | Timeframe is captured so staff can prioritize scheduling, but it's deliberately weighted below visit reason so a patient in no rush for a wellness exam still isn't scored higher than someone managing an active condition. |
| Do you have current health insurance coverage? | Insurance status doesn't carry a scoring weight but determines whether staff need to run an eligibility check or discuss self-pay options before the appointment is confirmed. |
| Do you currently take any regular prescription medications? | Knowing upfront whether a patient takes regular medications lets staff prepare for medication reconciliation instead of discovering a complex medication list mid-visit. |
| Who is this visit being scheduled for? | Identifying whether the visit is for the person completing the form, their child, or another family member tells staff whose records and history need to be pulled before the appointment. |
How Cliont scores new patient visit leads
Every answer is weighted automatically — no manual review required.
Value signals
- Seeking Establish Ongoing Care: yes
- General checkup or wellness exam
- Managing an ongoing health condition
- New symptom or health concern
- Medication refill or review
- Following up on a referral
See the lead your team receives
New Patient Visit 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 new patient visit workflows
| Cliont capability | New Patient Visit application |
|---|---|
| Branching answer logic | When a patient selects 'Not sure' for insurance coverage, the intake can route that lead into a verification step instead of dropping it, keeping uncertain-coverage patients from silently falling through. |
| Structured reason-for-visit capture | The single-choice reason field (checkup, ongoing condition, new symptom, refill, referral, other) lets staff sort new-patient leads by clinical intent before they ever look at a chart. |
| Document collection on submission | Insurance card photos and ID uploads are collected alongside the intake answers so front desk staff aren't chasing paperwork after the appointment is already booked. |
| Automatic scoring on submission | Because ongoing-care intent and visit reason carry the heaviest weights, the score reflects clinical fit for establishing new-patient care rather than just how fast someone wants an appointment. |
| CRM delivery of qualified leads | Once a new-patient submission includes visit reason, insurance status, and medication history, it's sent to your CRM as a complete record instead of a bare name-and-phone-number lead. |
Common new patient visit lead scenarios
Establishing ongoing primary care
A patient answers yes to seeking ongoing care and selects a general checkup as the reason, which scores as a strong fit for a standard new-patient slot rather than an acute visit.
Transferring chronic condition care
The visit reason is managing an ongoing health condition and the patient wants to establish a new provider relationship, so the intake surfaces this as a higher-value, ongoing-care lead.
New symptom, wants to be seen soon
The patient selects a new symptom as the reason and 'as soon as possible' for timeframe; the intake still weighs the reason for visit most heavily rather than auto-flagging on speed alone.
Referral follow-up visit
The patient is following up on a referral, which the intake captures as the visit reason so front desk staff know to request referral paperwork before the appointment.
Booking for a child or family member
The person completing the form selects that the visit is for their child or another family member, and insurance status is unsure, prompting a verification step before scheduling.
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
New Patient Visit lead-intake FAQs
What happens if a patient answers 'Not sure' about their insurance coverage?
The intake still lets the patient continue and captures the uncertainty as its own option rather than forcing a yes/no answer, so your staff can follow up to verify eligibility before the appointment is confirmed.
Does the intake flag patients who want to be seen as soon as possible?
The intake records how soon a patient hopes to be seen, but that timeframe alone doesn't drive an automatic priority flag; the reason for the visit, such as managing an ongoing condition or reporting a new symptom, carries more weight in the score.
How does this intake differ from your Sick Visit intake?
New Patient Visit intake is built around establishing ongoing care and includes questions like whether the patient wants an ongoing provider relationship and who the visit is for, while a Sick Visit intake is scoped around a single acute concern rather than onboarding.
Does the intake capture whether a patient is on regular medications?
Yes, patients answer a yes/no question about current prescription medications, which lets staff prepare for medication reconciliation before the visit even starts.
Can the intake tell us if the visit is for a child rather than the adult filling out the form?
Yes, the intake asks who the visit is being scheduled for, myself, my child, or another family member, so front desk staff know whose history and paperwork to prepare rather than assuming the form-filler is the patient.
What if someone submits the form without insurance coverage?
The intake still records the response, whether they have coverage, don't, or aren't sure, and routes the lead to your CRM so staff can address self-pay or financial screening steps before confirming a slot.
Turn new patient visit visitors into qualified patients
Give every new patient visit visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.