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[  After a delay · Centred modal  ]

Dental appointment request in two short steps

Lets a dental clinic's visitors ask for an appointment without phoning: patient type, reason and a preferred day first, then name and mobile so reception can confirm.

Generate leadsHealthcare & clinicsLocal services
Set up your agentAll templates
promptGive this to your agent

“I own a dental clinic and half our new patients never call because they hate phoning. After someone has been on the site for about 20 seconds, pop up an appointment request: new or existing patient, what the visit is for, and a preferred day, then their name and mobile number so reception can text to confirm. Don't pester people, once every couple of weeks at most.”

How it behaves

Layout
Centred modal
Opens
20 seconds after the page loads.
Where
Every page
Devices
Every device
Shows
At most once every 14 days.
Size
Medium
Page behind it
Dimmed; a click outside closes it
Close button
Yes
Steps
2, with a progress bar
After submit
A short confirmation, then it closes

What it asks · 5

Step 1

  • Patient typerequiredSingle choice

    New patient · Existing patient

  • Reason for visitrequiredDropdown

    Check-up and clean · Tooth pain or emergency · Whitening · Invisalign consultation · Something else

  • Preferred dayDate

Step 2

  • Full namerequiredShort text
  • Mobile numberrequiredPhone

Answers are saved under each question's label, which is also the column in your CSV export.

Make it yours

  1. 01

    Connect your agent

    Claude Code, Cursor or any MCP client, with or without an account.

  2. 02

    Paste the prompt, in your words

    Change the business, the offer and the timing. The agent starts from this template and edits it.

  3. 03

    Publish and paste one script

    One tag per site serves every popup you publish on it.

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