Know which daytime sleepiness leads are worth appointment time
Ask patients how long they've been sleepy, whether it disrupts driving or work, and whether they've dozed off unintentionally — then attach sleep diaries and route scored leads straight to your CRM.
The exact intake your daytime sleepiness leads complete
This is the real 7-question guided intake for Daytime Sleepiness — the same flow your customers finish before you ever pick up the phone.
What a qualified daytime sleepiness lead should tell you
Intake for patients reporting excessive daytime sleepiness, used to capture how long symptoms have lasted, whether they interfere with work, school, or driving, and whether the patient has ever dozed off unintentionally, before a sleep medicine visit is booked.
- Long Have Been Experiencing
- Sleepiness Interfere With Daily
- Ever Fallen Asleep Unintentionally
- Following Best Describes Typical
- Doctor Or Sleep Specialist
- Factors Believe Contribute Daytime
- Patient, Or Completing This
The questions your team needs answered
Every daytime sleepiness intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| How long have you been experiencing excessive daytime sleepiness? | Longer duration of sleepiness scores higher, helping surface patients whose symptoms have been persistent rather than a brief one-off. |
| Does the sleepiness interfere with daily activities such as work, school, or driving? | Sleepiness that interferes with work, school, or driving is weighted heaviest, since it signals functional impairment that warrants faster attention. |
| Have you ever fallen asleep unintentionally during activities like driving or working? | An unintentional sleep episode while driving or working carries the highest weight in this intake, flagging a safety-relevant case. |
| Which of the following best describes your typical nighttime sleep pattern? | Segments the lead so you can route, price, and prioritize it correctly. |
| Has a doctor or sleep specialist evaluated you for this sleepiness before? | Knowing whether the patient was previously evaluated, diagnosed, or treated tells staff whether this is a new workup or a case that fell out of care. |
| Which factors do you believe contribute to your daytime sleepiness? | Contributing factors like snoring point toward an apnea-related cause, helping staff decide whether to route the patient toward a sleep apnea or snoring evaluation instead. |
| Are you the patient, or are you completing this on behalf of someone else? | Identifying whether the respondent is the patient or a caregiver changes how the practice should schedule and communicate about the visit. |
How Cliont scores daytime sleepiness leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 1 month
- 1 to 6 months
- More than 6 months
- Sleepiness Interfere With Daily: yes
- Ever Fallen Asleep Unintentionally: yes
See the lead your team receives
Daytime Sleepiness 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 daytime sleepiness workflows
| Cliont capability | Daytime Sleepiness application |
|---|---|
| Weighted lead scoring | Duration, daily-activity interference, and unintentional sleep episodes are weighted highest, so patients reporting dozing off while driving surface above those with mild, short-term tiredness. |
| Branching qualification logic | Contributing-factor answers such as snoring, shift work, or medication use can route the case toward an apnea-focused or lifestyle-focused review before the appointment is booked. |
| Prior-care history capture | The prior-evaluation question flags whether this is a first-time workup, an unresolved case, or a diagnosed-but-untreated patient, so staff can prep the right chart notes. |
| Respondent identification | The patient-vs-caregiver question tells your front desk who to call and how to phrase intake follow-up. |
| CRM routing | Scored daytime sleepiness leads are sent to your CRM with duration, interference, and unintentional-episode answers attached, so scheduling staff don't need to re-ask basic history. |
Common daytime sleepiness lead scenarios
Chronic, function-impairing sleepiness
Patient reports more than six months of sleepiness that interferes with work or driving — the duration and interference answers push this case to the top of the queue.
Sudden sleepiness with unintentional dozing
Symptom onset is under a month, but the patient has fallen asleep while driving or working, which flags a safety-relevant case even though short duration alone would score lower.
Shift-work related fatigue
Patient attributes sleepiness to an irregular schedule and short sleep duration rather than a suspected disorder, helping the practice separate lifestyle-driven fatigue from a clinical workup.
Previously diagnosed, currently untreated
Patient was diagnosed with a sleep disorder in the past but isn't currently treated, with snoring or breathing pauses noted as a contributing factor — a re-engagement case rather than a fresh evaluation.
Caregiver submitting on a patient's behalf
Someone other than the patient completes the intake, which changes how the practice should schedule and communicate about the appointment.
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 sleep medicine intake templates
Daytime Sleepiness lead-intake FAQs
How does the intake distinguish urgent sleepiness cases from routine fatigue?
Interference with driving or work and unintentional sleep episodes carry the heaviest weight in this intake, so a patient who has dozed off while driving scores higher than someone reporting mild tiredness, regardless of how long symptoms have lasted.
Can the intake tell if a patient has already been evaluated for this before?
Yes, patients select from never evaluated, evaluated with no diagnosis, diagnosed but untreated, or diagnosed and currently treated, so your team can see whether this is a new workup or a returning case before the appointment.
Does the form separate sleep apnea risk from other causes of sleepiness?
Patients can flag contributing factors like snoring or breathing pauses, stress, shift work, or medication use, helping you decide whether an apnea-focused workup or a referral toward your Sleep Apnea Evaluation or Snoring Evaluation intake is more appropriate.
What if someone fills this out for a family member instead of themselves?
The intake captures whether the respondent is the patient or a caregiver, so staff know to adjust how they schedule and communicate about the visit.
How is a lead scored if the patient can't identify a clear cause?
The sleep-pattern and contributing-factor questions both include a 'not sure' option, so an inconclusive answer doesn't block the intake — it's weighted alongside the duration and interference answers, which carry the most scoring weight.
Does this intake work for patients already on CPAP or other treatment?
A patient marked as diagnosed and currently treated still completes the intake, so your team can see they may need CPAP Management or Sleep Study follow-up rather than a fresh sleepiness workup.
Turn daytime sleepiness visitors into qualified patients
Give every daytime sleepiness visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.