Kidney stone intake that asks what your team actually needs to know
Patients report their symptoms, prior stone history, and imaging status upfront, then upload CT or ultrasound reports, so your team knows exactly who needs urgent evaluation before anyone calls the office.
The exact intake your kidney stone evaluation leads complete
This is the real 5-question guided intake for Kidney Stone Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified kidney stone evaluation lead should tell you
A urology intake that captures a patient's current symptoms, prior stone history, and any existing imaging results, so staff can gauge how likely the case is an active kidney stone and how quickly it needs to be seen.
- Symptoms Experiencing
- Ever Been Diagnosed With
- Had Any Imaging, Such
- Patient, Or Seeking This
- Soon Be Seen This
The questions your team needs answered
Every kidney stone evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What symptoms are you currently experiencing? | Symptom selections, especially fever/chills and blood in urine, carry the highest weight so staff can spot infection or obstruction risk immediately. |
| Have you ever been diagnosed with kidney stones before? | Knowing whether the patient has a prior stone diagnosis helps distinguish a first acute episode from a recurrent case with an established history. |
| Have you had any imaging, such as a CT scan or ultrasound, showing a stone? | Imaging status determines whether the visit can move straight to treatment planning or still needs a diagnostic scan first. |
| Are you the patient, or are you seeking this evaluation on behalf of someone else? | Flagging caregiver submissions ensures staff confirm consent and gather accurate symptom details directly from the patient before scheduling. |
| How soon are you looking to be seen for this evaluation? | The requested timeframe separates same-day pain emergencies from patients who are only exploring their options for now. |
How Cliont scores kidney stone evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Flank or back pain
- Blood in urine
- Nausea or vomiting
- Painful or burning urination
- Fever or chills
- No current symptoms
Urgency signals
- As soon as possible, symptoms are severe
See the lead your team receives
Kidney Stone Evaluation 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 kidney stone evaluation workflows
| Cliont capability | Kidney Stone Evaluation application |
|---|---|
| Weighted multi-select symptom capture | Automatically flags high-risk combinations, such as fever/chills alongside blood in urine, so staff can spot possible infection or obstruction risk before calling the patient back. |
| Document upload | Collects CT scans or ultrasound reports at intake so staff can confirm whether a stone is already imaged before the patient ever reaches the front desk. |
| Self vs. caregiver branching | Identifies when a caregiver or family member is submitting on the patient's behalf, so staff know to verify consent before confirming any appointment. |
| Urgency-based lead scoring | Uses the requested timeframe question to separate same-day pain cases from patients who are only exploring their options for now. |
Common kidney stone evaluation lead scenarios
Severe pain, no imaging yet
Flank pain and blood in urine with no prior diagnosis and no imaging done, requesting to be seen as soon as possible. The intake flags this as high-value and time-sensitive before it hits the schedule.
Confirmed stone, mild symptoms
Imaging already confirms a stone but the patient is only exploring options for now. Staff can see this is a lower-urgency, imaging-confirmed case worth a routine follow-up slot rather than an emergency one.
Caregiver submitting for a relative
A family member fills out the intake on behalf of the patient, with imaging results still pending. This flags the caregiver relationship so staff can confirm consent and contact details before booking.
Recurrent stone history with fever
A patient previously diagnosed with kidney stones now reports fever and chills alongside flank pain. The combination of prior diagnosis and infection-risk symptoms pushes this to the top of the queue.
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 urology intake templates
Kidney Stone Evaluation lead-intake FAQs
How does the intake tell apart an urgent kidney stone case from a routine one?
Symptom selections like fever/chills and blood in urine carry the highest weight, and combined with how soon the patient wants to be seen, the intake surfaces cases that need same-day attention ahead of exploratory inquiries.
What if the patient already has a CT scan or ultrasound from another provider?
The intake asks directly whether imaging confirmed a stone, is pending, or hasn't been done, and prompts the patient to upload the report so staff can see the imaging status before scheduling.
Can someone submit this intake on behalf of a patient?
Yes, the intake asks whether the person completing it is the patient or a caregiver, so staff know to verify consent and confirm details directly with the patient before booking.
Does the intake capture whether this is a first-time or recurrent kidney stone?
Yes, a direct yes/no question asks if the patient has ever been diagnosed with kidney stones before, which helps staff separate a first acute episode from an established recurrent case.
What happens with patients who report no current symptoms?
That answer carries a lower weight than active symptoms, so those leads still come through for review but are distinguishable from patients in acute pain when staff prioritize the queue.
Where do qualified kidney stone leads go once they're scored?
Qualified leads, along with their symptom answers and any uploaded imaging, are sent directly to your CRM so staff can review the full picture before scheduling an appointment.
Turn kidney stone evaluation visitors into qualified patients
Give every kidney stone evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.