Pregnancy care intake that captures trimester and monitoring risk up front
The intake asks whether the patient is currently pregnant, which trimester they're in, and whether an established prenatal provider is in place, then flags any higher-risk monitoring needs and collects prenatal records before the lead reaches your CRM.
Preview your pregnancy care intake
Explore 5 questions from the Pregnancy Care template. This interactive preview uses illustrative scoring and sample attachments. Open the full survey to try the complete intake.
What a qualified pregnancy care lead should tell you
Pregnancy care covers ongoing prenatal visits and monitoring for a confirmed pregnancy, and the intake needs to establish trimester, existing provider status, and any flagged monitoring needs before a slot is offered.
- Pregnant
- Stage Pregnancy In
- Have Established Prenatal Care
- Been Told This Pregnancy
- Pregnant Patient, Or Contacting
The questions your team needs answered
Every pregnancy care intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Are you currently pregnant? | Confirming an active pregnancy is the single biggest driver of lead value and separates true prenatal enquiries from general questions. |
| Which stage of pregnancy are you currently in? | Trimester tells staff how time-sensitive scheduling is and which type of prenatal visit to offer. |
| Do you currently have an established prenatal care provider? | Knowing whether a provider is already established distinguishes a new-patient intake from a transfer-of-care or second-opinion request. |
| Have you been told this pregnancy involves any additional monitoring needs? | Higher-risk monitoring answers carry the highest weight because these patients typically need faster scheduling with a provider equipped for complex cases. |
| Are you the pregnant patient, or contacting on behalf of someone else? | Flagging caregiver-submitted forms lets staff confirm details directly with the patient before booking the appointment slot. |
How Cliont scores pregnancy care leads
Configured answer weights help your team prioritize follow-up. Your team reviews each submission and decides the next step.
Value signals
- Pregnant: yes
- Yes, higher-risk monitoring
- No, standard monitoring
- Not sure
See an example lead handoff
Illustrative lead details and score show how a submission can reach your team.
Pregnancy Care 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 pregnancy care workflows
| Cliont capability | Pregnancy Care application |
|---|---|
| Conditional branching | Trimester and monitoring-needs questions only appear after a patient confirms she is currently pregnant, keeping the intake short for non-pregnant enquiries. |
| Weighted lead scoring | Higher-risk monitoring answers are weighted above standard or unsure responses, so the most time-sensitive pregnancy leads rise to the top of the queue. |
| Submitter identification | The intake distinguishes patient-submitted forms from caregiver-submitted ones, so staff know when to call the patient directly before confirming a slot. |
| CRM routing | Qualified pregnancy leads arrive in your CRM already tagged with trimester, provider status, and monitoring flag for faster triage. |
Example pregnancy care lead scenarios
Illustrative situations explain the intake questions and possible follow-up.
Higher-risk monitoring flagged
A patient in her third trimester reports she was told this pregnancy needs higher-risk monitoring, which scores the intake at its highest weight so staff can prioritize the appointment.
New patient, no provider yet
A first-trimester patient without an established prenatal care provider is routed as a standard new-patient case, distinct from someone transferring care mid-pregnancy.
Caregiver submits on her behalf
A family member fills out the form for a pregnant relative, so the intake flags it as caregiver-submitted and staff know to confirm details directly with the patient before booking.
Uncertain about stage or risk
A patient unsure of her trimester or whether monitoring has been flagged still gets forwarded, scored lower for certainty, so staff can call to clarify rather than lose the lead.
Connect Cliont to your workflow
Connect your CRM
HubSpot, HighLevel, monday.com
Connect your legal software
Lawmatics, MyCase, Clio Manage and Clio Grow
Notify your team
Email, SMS, Slack
Configure other destinations
Google Sheets, configured webhooks, Zapier and API workflows
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
Pregnancy Care lead-intake FAQs
How does the intake tell routine pregnancies apart from higher-risk ones?
The monitoring-needs question separates 'higher-risk monitoring,' 'standard monitoring,' and 'not sure' into different weights, so higher-risk answers surface with more priority for scheduling.
What happens when someone fills out the form for a pregnant family member instead of themselves?
The intake captures whether the submitter is the patient or a caregiver, so a caregiver-submitted lead is flagged for staff to confirm directly with the patient before an appointment is booked.
Does the intake ask what stage of pregnancy someone is in?
Yes, patients select first, second, third trimester, or not sure, which helps staff determine the right type of prenatal visit and how quickly to respond.
Can someone without an existing prenatal provider still qualify through this intake?
Yes, answering that they don't have an established provider doesn't disqualify the lead, it simply tells staff this is likely a new-patient intake rather than a transfer of care.
Is this the only intake available for women's health services?
No, Cliont also supports intake for annual gynecology visits, fertility evaluations, pelvic pain evaluations, menstrual concerns, menopause care, and contraception consultations.
What if a patient answers 'not sure' to trimester or monitoring questions?
Those answers are still scored and delivered to your CRM, just weighted for lower certainty, so front desk staff can follow up and fill in the gaps before booking.
Turn pregnancy care visitors into qualified patients
Give every pregnancy care visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.