Mood disorder intake that captures symptom duration and urgency up
The intake asks about symptom duration, daily-activity impact, and how soon care is needed, then requests any prior evaluation records or medication lists before the request reaches your CRM.
The exact intake your mood disorder evaluation leads complete
This is the real 6-question guided intake for Mood Disorder Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified mood disorder evaluation lead should tell you
An assessment of persistent mood symptoms—such as depression, mania, or unstable mood—used to establish a diagnosis and inform treatment planning, distinguishing new presentations from clients who have already been diagnosed or treated.
- This Evaluation
- Long Have Mood Symptoms
- Mood Symptoms Affecting Daily
- This Person Had Prior
- Person Attend Appointments Themselves,
- Soon Would Like This
The questions your team needs answered
Every mood disorder evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this evaluation for? | Knowing who the evaluation is for immediately signals whether a pediatric, adult, or guardian-consent workflow applies before the session is booked. |
| How long have the mood symptoms been present? | Longer symptom duration scores higher since months-long mood symptoms are less likely to resolve without evaluation, while 'not sure' still scores moderately because unclear onset often needs assessment too. |
| Are the mood symptoms affecting daily activities like work, school, or relationships? | Daily-activity impact is the strongest binary severity signal in the catalog, weighted well above cases where routines are largely unaffected. |
| Has this person had a prior diagnosis or treatment for a mood condition? | Prior diagnosis or treatment history tells staff whether this is a new workup or a reassessment, changing what records need to be requested before the session. |
| Can the person attend appointments themselves, or will someone else need to consent and participate on their behalf? | The consent pathway determines whether the client, a parent, or a legal representative must complete intake paperwork before scheduling can proceed. |
| How soon would you like this evaluation to take place? | Requested timeline is the most heavily weighted field in the catalog, separating clients who need a slot within days from those just exploring options. |
How Cliont scores mood disorder evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Less than 2 weeks
- 2 weeks to 3 months
- More than 3 months
- Not sure
- Mood Symptoms Affecting Daily: yes
- Within 2 weeks
Urgency signals
- Urgent, within days
See the lead your team receives
Mood Disorder 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 mood disorder evaluation workflows
| Cliont capability | Mood Disorder Evaluation application |
|---|---|
| Conditional consent routing | When the consent field shows a parent, guardian, or legal representative, Cliont flags the lead so the right paperwork is ready before the session is confirmed. |
| Weighted scoring | Symptom duration and daily-activity impact combine so a client with months of symptoms affecting work or relationships surfaces above someone unsure how long symptoms have lasted. |
| Urgency-based routing | 'Urgent, within days' timeline answers can be routed differently from 'just exploring options,' so staff see which requests need a same-week slot without reading every response. |
| Document upload | Clients marked as previously diagnosed or currently in treatment can attach prior records so the intake session isn't spent re-collecting history that already exists. |
| CRM handoff | Every qualified request arrives in your CRM already labeled with who it's for—self, child, partner, or dependent adult—so the consent workflow is clear before first contact. |
Common mood disorder evaluation lead scenarios
Adult self-referral, long-standing symptoms
Symptoms present for more than three months are affecting work or relationships, and the person wants an evaluation within days—this combination scores highest across the catalog.
Parent flagging a teenager's mood changes
The evaluation is for a child or teen who has never been evaluated before, so the consent field routes the lead as needing guardian sign-off before a session can be confirmed.
Caregiver exploring options for a dependent adult
A relative is asking on behalf of a dependent adult but selects 'just exploring options,' so the intake still records the case without implying same-week urgency.
Returning patient reassessing ongoing treatment
The client is currently in treatment and wants a follow-up within a month, which the intake distinguishes from a first-time workup using the prior diagnosis field.
Partner concerned about a sudden change
Symptoms have been present less than two weeks but are already disrupting daily activities, and the requested timeline is urgent—flagging a fast-moving case despite the shorter duration.
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 psychiatry intake templates
Mood Disorder Evaluation lead-intake FAQs
How does the intake handle evaluations requested on behalf of someone else?
The catalog asks who the evaluation is for and whether the person can consent themselves or needs a parent, guardian, or legal representative involved, so staff know exactly whose signature is required before scheduling.
Does the intake treat every symptom duration the same way?
No—duration options are weighted from 4 to 9, with longer-standing and 'not sure' responses both scoring meaningfully, since unclear onset still warrants an evaluation rather than being deprioritized.
What if a client says their mood symptoms aren't really affecting daily life?
That answer is still captured but weighted lower than a 'yes,' so you can see at a glance which requests reflect functional impairment versus milder concerns.
Can I tell if someone has been diagnosed or treated before?
Yes, the intake records whether this is a first-time evaluation, a prior diagnosis, or ongoing treatment, which helps staff decide what records to request ahead of the session.
How is urgency represented in the score?
The requested timeline is the most heavily weighted single field, ranging from 'urgent, within days' at 10 down to 'just exploring options' at 3, so time-sensitive requests stand out immediately.
Does this same intake cover anxiety or sleep concerns instead?
No, this catalog is specific to mood disorder symptoms; Anxiety Disorder Evaluation and Sleep-Related Mental Health Evaluation are separate sibling intakes.
Turn mood disorder evaluation visitors into qualified patients
Give every mood disorder evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.