Prostate intake that captures PSA history up front
Patients tell you why they're seeking evaluation, whether they're experiencing pain or urinary changes, and how soon they need to be seen—plus upload prior PSA results or biopsy reports before the first call.
The exact intake your prostate evaluation leads complete
This is the real 6-question guided intake for Prostate Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified prostate evaluation lead should tell you
A structured intake to determine why a patient needs a prostate evaluation—new symptoms, an abnormal PSA result, routine screening, or follow-up—so staff can confirm eligibility and urgency before scheduling.
- Main Reason Seeking Prostate
- Experiencing Pain, Blood In
- Had Any Prior Prostate
- Soon Be Seen This
- This Evaluation Yourself, Or
- Have Family History Prostate
The questions your team needs answered
Every prostate evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| What is the main reason you are seeking a prostate evaluation? | The reason-for-evaluation answer carries the top single weight in the catalog and determines whether this is a routine screening or a result-driven case needing faster review. |
| Are you currently experiencing pain, blood in urine, or difficulty urinating? | A yes on pain, blood in urine, or difficulty urinating adds the highest urgency weight and should trigger a same-week scheduling review. |
| Have you had any prior prostate tests, biopsies, or treatments? | Knowing whether the patient already has PSA, biopsy, or imaging results shapes what documentation staff need to request before the visit. |
| How soon are you hoping to be seen for this evaluation? | The desired timing answer separates patients who need to be seen within days from those still exploring, directly informing how fast staff should respond. |
| Is this evaluation for yourself, or are you inquiring on behalf of someone else? | Identifying caregiver-submitted intakes lets staff confirm consent and patient identity before a slot is booked. |
| Do you have a family history of prostate cancer? | Family history adds clinical risk context for the visit even though it isn't independently weighted in the scoring model. |
How Cliont scores prostate evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- New or worsening urinary symptoms
- Routine age-related screening
- Abnormal PSA or exam result
- Follow-up for a known prostate condition
- Other reason
- Experiencing Pain, Blood In: yes
See the lead your team receives
Prostate 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 prostate evaluation workflows
| Cliont capability | Prostate Evaluation application |
|---|---|
| Guided branching logic | The reason-for-visit question routes differently depending on whether the patient selects an abnormal result, routine screening, or a follow-up, before combining with the symptom question. |
| Document upload capture | Patients who report a prior biopsy or imaging are prompted to upload that report, so staff aren't scheduling blind on cases with existing clinical history. |
| Lead scoring engine | An abnormal PSA reason, a yes on pain or urinary symptoms, and a 'within the next few days' timing answer together push a lead into the highest scoring band automatically. |
| Caregiver detection | The self-or-family-member question flags caregiver-submitted intakes for staff to confirm patient identity and consent before a slot is confirmed. |
| CRM routing | Leads with abnormal PSA results or active urinary symptoms are sent to the CRM immediately so front-desk staff can prioritize outreach over routine screening requests. |
Common prostate evaluation lead scenarios
Abnormal PSA needing fast follow-up
Patient selects an abnormal PSA or exam result, confirms pain or urinary difficulty, and asks to be seen within days—the intake surfaces this as an urgent, high-value case.
Routine screening, no symptoms
Patient is booking a standard age-related screening with no pain or urinary changes and no rush on timing, so the intake routes it as a normal-priority visit rather than urgent.
Follow-up for a known condition
Patient has a prior treatment or procedure on record and family history of prostate cancer, giving staff clinical context for a monitoring visit rather than a new workup.
Caregiver inquiring for a family member
The intake is submitted on behalf of a family member instead of the patient themselves, flagging the need to confirm identity and consent before a slot is booked.
Just exploring, not ready to book
Patient picks 'other reason' with no urgency and marks themselves as 'just exploring options,' signaling a lead that needs nurturing rather than immediate 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 urology intake templates
Prostate Evaluation lead-intake FAQs
How does the intake flag a patient with an abnormal PSA result?
When a patient selects 'Abnormal PSA or exam result' as their reason and confirms current pain, blood in urine, or difficulty urinating, both answers carry the highest weights in the catalog, so the lead scores as high priority for a near-term appointment.
Can a caregiver submit the intake instead of the patient?
Yes—the intake asks directly whether the evaluation is for the patient or on behalf of someone else, so staff can see caregiver-submitted leads and confirm consent before scheduling.
What happens if the patient isn't sure about their prior testing history?
The intake includes a 'Not sure' option for prior PSA tests, biopsies, or treatments, so uncertain patients still complete the form and staff can follow up to clarify before the visit.
Does the intake ask about family history of prostate cancer?
Yes, patients answer a yes/no question on family history, which is captured as clinical context alongside their stated reason and symptoms rather than as a separate urgency signal.
How is urgency determined for scheduling priority?
Patients select how soon they hope to be seen, ranging from within the next few days to just exploring options, and that answer combines with their reason and symptom status to set the overall lead score.
What documents should patients upload before their appointment?
Patients who've already had testing are prompted to upload a recent PSA lab report or prior biopsy or imaging report, giving staff documentation to review before the first call.
Turn prostate evaluation visitors into qualified patients
Give every prostate evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.