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Quiz for booking a teeth cleaning

A ready-made template for dental practices: the patient marks their concerns (sensitivity, bleeding), notes recent procedures, chooses one of your locations and picks a time that works for the cleaning.
Who it is for
Dental practices and multi-location dental groups
When to use it
Cleaning is a recurring service, and booking it should take a minute
What it does
Books the cleaning and tells the hygienist about the patient's specifics in advance

Use this template for your business

It is copied to your dashboard in one click: replace the questions and texts with your own and publish it on your website.
Use this template
Free, with 20 free leads

How it works

Professional cleaning is a practice's highest-volume and most underrated service: it brings in new patients and brings regulars back every six months. That's why the path to booking should be short, and the template delivers: four steps to choosing a time.

Two of those questions also have practical value for the hygienist. Gum concerns (sensitivity, bleeding) affect the technique and how much time to block in the schedule. Recent procedures (implants, crowns, braces or aligners) determine which tips and modes can be used. Knowing all this before the appointment is more useful than finding out with the patient already in the chair.

Still, the quiz is a booking form, not a medical questionnaire: there's no need to collect health details, the dentist asks about those in person. Choosing a location from a list handles routing for a multi-location group: the addresses in the template are examples, so replace them with yours. The reward for booking, as in the template, works gently here: a take-home toothpaste is an inexpensive, fitting bonus for a recurring service.

FAQ
The template is free. You only pay for leads: 20 free leads when you sign up, no expiration, then from $0.20 per lead or unlimited from $19/month.
They affect the cleaning technique and the appointment length: with bleeding gums or recent implants, the hygienist works differently. It's preparation, not diagnosis.
No. The patient picks a time that works, it arrives with the request, and the front desk confirms the appointment; if needed, the request can be sent to the practice's CRM.
Keep the addresses as answer options and replace them with yours. The request arrives with the chosen location and goes to the right front desk.
No, the quiz doesn't accept payments. It calculates the cost and passes on the request; payment is handled at the practice as usual.
We will help you adapt the template
Tell us what you need: and we will show you how to set up the quiz.

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