Turn fertility evaluation enquiries into appointment-ready leads
Patients share how long they've been trying to conceive, their age range, and any prior fertility testing before booking — with test results and lab reports uploaded upfront so your team sees the full picture before the first visit.
The exact intake your fertility evaluation leads complete
This is the real 5-question guided intake for Fertility Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified fertility evaluation lead should tell you
A diagnostic intake for individuals or couples who have been trying to conceive, capturing time trying, age, prior testing history, and suspected cause so the clinic can determine the right first appointment.
- Seeking This Fertility Evaluation
- Long Have Been Trying
- Had Any Prior Fertility
- Following Best Describes Primary
- Age Range
The questions your team needs answered
Every fertility evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is seeking this fertility evaluation? | Distinguishes whether one or two calendar slots and intake profiles need to be prepared for the appointment. |
| How long have you been trying to conceive without success? | Longer time trying to conceive without success carries the heaviest weight, since it signals a stronger clinical case for evaluation. |
| Have you had any prior fertility testing or treatment? | Knowing about prior fertility testing or treatment helps the clinician avoid duplicate diagnostics and review existing findings first. |
| Which of the following best describes your primary fertility concern? | The primary concern selected, such as suspected male factor, determines whether a partner referral needs to be coordinated alongside the evaluation. |
| What is your age range? | Age range is weighted into the score because fertility decline accelerates with age, making leads 35 and older more time-sensitive. |
How Cliont scores fertility evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 6 months
- 6 to 12 months
- More than 12 months
- Under 30
- 30 to 34
- 35 to 39
Urgency signals
- Not actively trying yet
See the lead your team receives
Fertility 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 fertility evaluation workflows
| Cliont capability | Fertility Evaluation application |
|---|---|
| Adaptive lead scoring | Combines duration trying to conceive with age range so a 35-year-old trying for over a year scores as high priority even without prior testing. |
| Branching multi-select questions | When a lead selects suspected male factor as the primary concern, the intake surfaces that a partner referral or semen analysis may need to be scheduled. |
| Individual vs. couple routing | The 'who is seeking this evaluation' answer determines whether the CRM entry needs to hold profiles and calendar time for one patient or two. |
| Document upload at intake | Patients with prior fertility testing can upload lab reports or test results so the clinician reviews history before the appointment instead of during it. |
| Segment flagging outside the standard score | Leads answering 'not actively trying yet' are tagged separately from active TTC cases so they don't get scheduled into a fertility workup slot by mistake. |
Common fertility evaluation lead scenarios
Long-standing unexplained infertility
A couple trying for more than 12 months with no known cause and no prior workup scores high, since duration without success carries the heaviest weight in the intake.
Advanced maternal age, moving fast
An individual woman aged 40 and over who has only been trying 6 to 12 months still scores high because age weight compounds with duration, flagging her for a prompt appointment.
Early-stage, no concern yet
A woman under 30 who has been trying less than 6 months with no specific concern selected scores lower, so front desk can offer a lighter-touch first conversation instead of a full workup slot.
Not actively trying yet
Someone who selects 'not actively trying yet' is flagged separately from active TTC leads, letting the clinic route them to preconception counseling rather than a fertility workup appointment.
Suspected male factor referral
A couple selecting suspected male factor as their primary concern signals that a partner semen analysis or referral likely needs to be coordinated alongside the woman's evaluation.
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 women's health intake templates
Fertility Evaluation lead-intake FAQs
How does the intake prioritize leads who have been trying longer without success?
Time trying to conceive carries the heaviest weight in the scoring model, so answers of 6 to 12 months or more than 12 months push a lead's score up compared to someone trying less than 6 months.
What happens with patients who say they're 'not actively trying yet'?
That answer is flagged as its own segment rather than scored like an active fertility case, so staff can route it to preconception counseling instead of booking a full evaluation slot.
Can the intake tell whether it's a couple or an individual seeking evaluation?
Yes — the first question captures whether the lead is an individual woman, a couple, or an individual man, which determines whether one or two calendar slots and intake profiles need to be prepared.
Does the intake ask about prior fertility testing or treatment?
Yes, patients confirm whether they've had prior testing or treatment, which helps the clinician avoid ordering duplicate diagnostics and review existing findings before the visit.
How does age factor into whether a lead gets flagged as high priority?
Age range is scored on its own axis, with 35 to 39 and 40-and-over weighted highest, since these bands typically warrant more time-sensitive scheduling.
What if a patient selects multiple fertility concerns, like irregular cycles and suspected male factor?
The primary concern question allows multiple selections, so a lead flagged for suspected male factor can be routed toward coordinating partner testing alongside the woman's evaluation.
Turn fertility evaluation visitors into qualified patients
Give every fertility evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.