Sample Intake Form

This is a demo example only — a display-only sample, not a working form. Final fields and wording are approved by you before anything goes live.

Sample / demo onlyDisplay only — not connected

What a simple intake path asks

When a call is missed or an inquiry comes in, the customer can be pointed to a short intake form like this one — by a voicemail message, a link, or your website. It asks only what your team needs to follow up well.

Request a callback

Sample

Your name

e.g. Sample Customer

So your team knows who to ask for on the callback.

Phone or email

e.g. (555) 010-0123

How the business can reach you back.

What do you need help with?

e.g. Furnace making a loud noise

A short description of the service issue.

Service address or area

e.g. Northwest end of town

Enough location detail to confirm you're in the service area.

How soon do you need this?

e.g. As soon as possible

Helps your team prioritize the follow-up.

Best time for a callback

e.g. Today, after 4:00 PM

When a person should call back.

Submit (sample only — this form is not connected)

Why these fields

Each answer maps directly to a line in the structured lead summary your team receives: who to call, how to reach them, what they need, where they are, how urgent it is, and when to call back. No accounts, no apps, no long questionnaires.

See the result in the Sample Lead Summary.

What happens after submission

The details are organized into a lead summary and sent to your team. A person reviews it and follows up — AI-assisted, not fully autonomous. Nothing is booked or promised to the customer automatically.

See if it fits your business

Wondering where your own site is losing calls and quote requests? Start with a free Lead Flow Snapshot.

Get a free Lead Flow Snapshot

Or email sales@fortaisystems.com.

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