New-Patient Intake Call Checklist

Date:   Time:   Taken by:  

Opening

Suggested greeting: "Thank you for calling [practice name], this is [your name]. How can I help you?"

Caller details

• Patient full name:   Preferred name:  
• Date of birth:  
• Best phone:   OK to text? [ ] Yes [ ] No
• Email:   OK to email? [ ] Yes [ ] No
• Address:  
• Booking for self, or for someone else (name and relationship):  

How they found us

[ ] Referral from:   [ ] Search [ ] Website [ ] Social [ ] Walk-by [ ] Other:  

Reason for the call (in the caller's own words)

 
If the caller describes severe pain, swelling, bleeding or an accident, use the Emergency / After-Hours Call Handling Checklist and follow your dentist's instructions.

Coverage

[ ] Has insurance [ ] No insurance [ ] Not sure

• Plan / company name:   Group #:   Member ID:  
• Policy holder name and date of birth:  
• Told caller we will verify benefits and cannot guarantee coverage: [ ] Yes

Booking

• Preferred days / times:  
• Appointment booked: Date   Time   With  
• Forms: [ ] Sent link [ ] Email [ ] Fill in at office (arrive   minutes early)
• Remind the caller to bring: photo ID, insurance card, a list of their current medications, and any records they want to share

Close

• Repeated back the date, time, address and phone number
• Gave parking / directions:  
• Explained our cancellation policy:  
• Thanked them by name

Notes:  

Follow HIPAA (US) / your provincial privacy law (Canada) and your office policy when collecting and storing patient information.