Sick visit intake that asks what your team actually needs to know
Patients share how long they've had symptoms, whether their case is mild enough for a routine visit, and what they're experiencing before you ever open your CRM. Photos of visible symptoms are collected up front so your team can triage without guessing.
Preview your sick visit intake
Explore 6 questions from the Sick Visit template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified sick visit lead should tell you
A primary care visit to evaluate acute, non-emergency symptoms such as fever, cough, sore throat, or stomach upset, where duration and severity are screened up front to confirm the case fits a routine slot.
- Long Have Had These
- Symptoms Mild Enough Routine
- Best Describes Main Symptoms
- This Visit New Health
- Work Or School Excuse
- Already Tried Any Over-
The questions your team needs answered
Every sick visit intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How long have you had these symptoms? | How long symptoms have persisted helps staff judge whether the case still fits a standard sick visit slot or needs closer review. |
| Are your symptoms mild enough for a routine sick visit, without severe signs like trouble breathing or chest pain? | This yes/no answer is weighted heavily (10 versus 1) because it separates patients safe for a routine visit from those who may need urgent care instead. |
| Which best describes your main symptoms? | Knowing the primary symptom cluster lets the provider prepare before the visit instead of gathering this information during the appointment. |
| Is this visit for a new health concern or a follow-up on symptoms you've already discussed with a provider? | Distinguishing a new concern from a follow-up tells staff whether prior notes need to be pulled before the visit. |
| Do you need a work or school excuse note for this visit? | Flags an administrative need up front so the front desk can prepare documentation without extending the visit itself. |
| Have you already tried any over-the-counter medication for these symptoms? | Knowing what the patient already tried at home helps the provider avoid suggesting something that already failed. |
How Cliont scores sick visit leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Symptoms Mild Enough Routine: yes
Urgency signals
- Symptoms Mild Enough Routine
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Sick 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 sick visit workflows
| Cliont capability | Sick Visit application |
|---|---|
| Severity gate screening | Uses the severity screening yes/no answer to flag patients whose symptoms may not be safe for a routine slot, before staff ever see the request. |
| Symptom summary handoff | Compiles the multi-select symptom answers into a note visible in the CRM so the provider knows the main complaint before the visit starts. |
| Duration-based triage cue | Surfaces how long symptoms have lasted alongside the severity answer, helping staff judge how quickly the appointment should happen. |
| Administrative flagging | Tags excuse-note requests separately from the medical complaint so front desk staff can prepare documentation without extending the visit. |
Example sick visit lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Mild cold symptoms, new concern
Short duration, a mild severity screening answer, and a new-concern selection point toward a straightforward routine booking.
Red-flag symptoms reported
A 'no' on the severity screening question signals this patient may need urgent care rather than a standard sick visit slot, so staff see the flag before confirming any booking.
Follow-up on treated symptoms
Marking the visit as a follow-up rather than a new concern tells staff to pull prior notes instead of starting the intake picture from zero.
Excuse note requested
A yes on the work or school note question adds an administrative task the front desk can prepare for ahead of the visit.
Week-long symptoms, OTC already tried
Longer duration combined with a 'yes' on prior over-the-counter treatment suggests the case may need closer review before it's treated as routine.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
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
Sick Visit lead-intake FAQs
How does the intake screen out patients who might need emergency care instead of a sick visit?
The severity screening question carries a much higher weight for 'yes' than 'no', so a 'no' answer (indicating signs like trouble breathing or chest pain) flags the lead for review before it's treated as a routine booking.
Can patients request a work or school excuse note through the intake?
Yes, the excuse note question is a simple yes/no field, and a 'yes' answer gets flagged so the front desk can have documentation ready before the visit.
How does the intake handle follow-up visits differently from new symptoms?
The visit-type question separates a new health concern from a follow-up, so staff know to pull prior notes for follow-ups rather than starting from scratch.
What happens if a patient has had symptoms for over a week?
The duration question captures this directly, and a longer duration alongside other answers can prompt a closer look before the slot is confirmed as routine.
Does the intake ask what the patient has already tried at home?
Yes, a yes/no question captures whether over-the-counter medication has already been tried, so the provider isn't repeating something that didn't work.
How is this different from Cliont's New Patient Visit or Preoperative Clearance intakes?
Each subservice uses its own question set; the sick visit catalog is built around symptom duration, severity, and type rather than medical history or surgical readiness.
Turn sick visit visitors into qualified patients
Give every sick visit visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.