Know which chronic care follow-up leads are worth appointment time
Patients confirm their diagnosed condition, who currently manages treatment, and how soon they need their next visit, while uploading a current medication list so your team knows exactly who is ready for a follow-up slot.
The exact intake your chronic care follow-up leads complete
This is the real 6-question guided intake for Chronic Care Follow-Up — the same flow your customers finish before you ever pick up the phone.
What a qualified chronic care follow-up lead should tell you
A virtual check-in for a patient already diagnosed with an ongoing condition, used to confirm who is currently managing their treatment, how soon they need the next visit, and whether medication and location details support booking a telemedicine slot.
- Already Been Diagnosed With
- Chronic Condition Seeking Follow-Up
- Manages This Condition'S Ongoing
- Soon Would Like Next
- Taking Prescribed Medication This
- In Which State Located
The questions your team needs answered
Every chronic care follow-up intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Have you already been diagnosed with the chronic condition you want follow-up care for? | A confirmed diagnosis distinguishes an established chronic care patient, weighted at 10, from someone effectively seeking a first-time diagnosis, weighted at only 2. |
| What type of chronic condition are you seeking follow-up for? | Segments the lead so you can route, price, and prioritize it correctly. |
| Who currently manages this condition's ongoing treatment plan? | Whether a provider is actively managing the condition signals how much clinical continuity already exists, with weights ranging from 9 down to 4 depending on the answer. |
| How soon would you like your next follow-up visit? | Segments the lead so you can route, price, and prioritize it correctly. |
| Are you currently taking prescribed medication for this condition? | Confirms whether medication management needs to be part of the follow-up visit, so the clinician can prepare before the call rather than during it. |
| In which state are you currently located for this telemedicine visit? | The patient's current state determines whether the assigned clinician is licensed to treat them by telemedicine before any slot is confirmed. |
How Cliont scores chronic care follow-up leads
Every answer is weighted automatically — no manual review required.
Value signals
- Already Been Diagnosed With: yes
- A provider I see regularly
- A provider I saw before but not currently
- No provider currently managing it
- Not sure
See the lead your team receives
Chronic Care Follow-Up 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 care follow-up workflows
| Cliont capability | Chronic Care Follow-Up application |
|---|---|
| Lead scoring engine | Weights confirmed diagnosis and active provider management above scheduling preference, so an established chronic care patient ranks above a one-off, unmanaged inquiry. |
| Conditional branching | Flags patients who select 'No provider currently managing it' or 'Not sure' for their treatment manager, so front-desk staff can review continuity of care before booking. |
| State/location capture | Collects the patient's current state as free text so staff can confirm the assigned clinician is licensed there before a video slot is confirmed. |
| CRM routing | Sends qualified chronic care follow-up patients into the CRM with condition type, provider-management status, and medication status pre-filled for the clinician. |
Common chronic care follow-up lead scenarios
Established diabetic due for review
Patient confirms a prior diabetes diagnosis, names a provider who sees them regularly, and wants a visit this week — the highest-weighted combination for continuity of care.
Diagnosed but currently unmanaged
Patient answers yes to being diagnosed but selects 'No provider currently managing it,' flagging a care gap the clinician should address before treating the follow-up as routine.
No formal diagnosis yet
Patient answers no to the diagnosis question, which the intake weights far lower since this service is built for existing chronic care, not initial diagnostic workups.
Lapsed care, re-engaging now
Patient selects 'A provider I saw before but not currently,' suggesting they fell out of active management and need the visit framed as re-establishing care rather than a routine check-in.
Out-of-state visit request
The free-text state field shows the patient is located outside the clinician's usual coverage area, prompting a licensing check before any slot is confirmed.
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 telemedicine intake templates
Chronic Care Follow-Up lead-intake FAQs
What happens if a patient hasn't actually been diagnosed yet?
The intake asks directly whether the patient has already been diagnosed with the condition, and a 'no' answer is weighted much lower than a confirmed diagnosis, since this follow-up service assumes an existing chronic condition rather than a first-time workup.
Does the intake check whether the patient is currently seeing a provider for the condition?
Yes — it asks who currently manages the patient's treatment plan, with a regular provider scoring highest and 'No provider currently managing it' or 'Not sure' scoring lower, so staff can see continuity-of-care gaps before the call.
Can I tell which condition a patient is following up for before I call them?
Yes, the intake asks patients to select their condition type (diabetes, hypertension, heart disease, a respiratory condition, or other), which is delivered with the lead so the assigned clinician can prepare in advance.
Does the form confirm whether the patient is on medication for the condition?
Yes, it asks a direct yes/no question about current prescribed medication, giving the clinician context on treatment status ahead of the visit.
How does the intake handle patients in a different state than my licensed coverage?
The intake collects the patient's current state as a free-text field so your team can confirm licensure and telemedicine eligibility before confirming an appointment.
How is scheduling urgency captured for chronic care follow-ups?
Patients choose from as soon as possible, this week, this month, or flexible timing, which the intake surfaces alongside diagnosis and provider-management answers so staff can prioritize scheduling accordingly.
Turn chronic care follow-up visitors into qualified patients
Give every chronic care follow-up visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.