Medical weight management intake that captures medication readiness up
The intake captures each patient's main goal, openness to prescription medication, and desired start timeline before your team ever calls back, and requests medical records or labs so providers walk into the first visit prepared.
The exact intake your medical weight management leads complete
This is the real 7-question guided intake for Medical Weight Management — the same flow your customers finish before you ever pick up the phone.
What a qualified medical weight management lead should tell you
Physician-guided intake for patients seeking medically supervised weight management, covering their treatment goal, current medical oversight, and openness to prescription support before a provider gets involved.
- This Weight Management Inquiry
- Previously Tried Structured Weight
- Main Goal Seeking This
- Under Care Doctor Any
- Open Using Prescription Medication
- Soon Would Like Begin
- Have Recent Medical Records
The questions your team needs answered
Every medical weight management intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this weight management inquiry for? | Identifies whether the patient is the intended recipient of care or a proxy for a child or dependent adult, which changes the intake and consent path. |
| Have you previously tried a structured weight management program with a provider? | Separates real opportunities from leads that aren’t a fit yet. |
| What is your main goal for seeking this service? | Weighted goal answers separate condition-management and weight-loss intent from general information seekers, surfacing the leads most likely to book. |
| Are you currently under the care of a doctor for any ongoing medical condition? | Flags patients already managing an ongoing condition under a doctor, which may require coordinating care before starting a new program. |
| Are you open to using prescription medication as part of a weight management plan? | The weighted yes/no on medication openness signals treatment fit and helps staff match patients to medication-eligible providers. |
| How soon would you like to begin a weight management program? | An immediate start selection is the specific signal used to flag a lead as urgent, letting staff prioritize scheduling outreach. |
| Do you have recent medical records or lab results you could share with a provider? | Confirms whether medical records or labs are ready to share, letting staff request documentation before the first appointment instead of during it. |
How Cliont scores medical weight management leads
Every answer is weighted automatically — no manual review required.
Value signals
- Lose weight
- Manage a weight-related health condition
- Maintain current weight with guidance
- General information only
- Open Using Prescription Medication: yes
Urgency signals
- Immediately
See the lead your team receives
Medical Weight Management 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 medical weight management workflows
| Cliont capability | Medical Weight Management application |
|---|---|
| Video intake widget | Patients can describe their current health condition and goal on camera before staff review any medical records they've uploaded. |
| Conditional scoring logic | Weighs an immediate start timeline and prescription-medication openness higher, automatically prioritizing ready-to-book patients over general-information browsers. |
| Document upload | Collects recent medical records or lab results ahead of the visit so providers arrive with clinical context instead of gathering it live. |
| CRM routing | Sends qualified medical weight management leads into your CRM with goal, medication openness, and timeline already attached to the record. |
| Proxy/dependent flagging | Flags when the inquiry is submitted for a child, teen, or another adult, so staff can route to an age-appropriate intake path instead of the standard adult workflow. |
Common medical weight management lead scenarios
Ready to start immediately
Patient selects a goal of managing a weight-related health condition, is open to prescription medication, and wants to begin immediately, producing a high-priority lead your team can book right away.
Just exploring options
Patient selects general information only and is just exploring timing, so the lead scores lower and can be nurtured instead of pulled into a scheduling slot.
Inquiry for a child or teen
The inquiry-for question flags a minor rather than the adult filling out the form, letting staff route to a pediatric-appropriate path instead of the standard adult intake.
Returning, well-documented patient
Patient reports prior structured program experience, is currently under a doctor's care, and has medical records ready to share, giving staff a fuller clinical picture before the first call.
Maintenance without medication interest
Patient's goal is maintaining current weight with guidance and they decline interest in prescription medication, which scores differently than a weight-loss or condition-management lead and helps staff match the right service track.
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 weight management intake templates
Medical Weight Management lead-intake FAQs
How does the intake handle inquiries submitted on behalf of someone else?
The who-is-this-for question separates self, child/teen, and another adult, so staff can flag proxy or pediatric inquiries and route them to the appropriate intake path before booking.
Does the intake surface interest in prescription medication?
Yes — the medication-openness question is weighted higher for a yes answer, giving staff visibility into treatment fit before the appointment is confirmed.
Can patients share medical records or lab results before the visit?
The intake asks whether the patient has recent records or labs available, so staff can request documentation upfront instead of chasing it down during the appointment.
How does the intake flag urgency?
Patients who select an immediate start timeline are treated as the urgent segment, letting staff prioritize outreach and offer closer scheduling slots to leads that are ready now.
Are general-information seekers treated differently from weight-loss patients?
The main-goal question weights general information lower than weight loss or condition management, so front-desk staff can see at a glance which leads are closer to committing to care.
Does the intake ask whether a patient is already under a doctor's care?
Yes, so staff can flag patients managing an existing condition who may need coordination with their current provider before starting a new program.
How does the intake account for patients who've tried a program before?
Prior structured-program history is captured directly, giving staff context on whether this is a first attempt or a return patient before the first conversation.
Turn medical weight management visitors into qualified patients
Give every medical weight management visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.