Functional Medicine Power Hour (3 Pay)

Hi! Congratulations!! I’m excited to have a Functional Medicine Power Hour with you to help you get clear about how to proceed in a way that’s legally sound.

Please fill out this Prep Sheet to the best of your ability to help me know more about you and your business/practice prior to your call. Thank you in advance for answering these questions.

Providing as much detail as possible will maximize our time together, and help you move more quickly towards your next legal step, saving you both time and money.

Once you submit this Prep Sheet, you'll receive a copy of your response, and will be directed to the checkout page where you can complete your purchase. After you've made your purchase, watch an email to arrive with the link to schedule your call and a receipt.
About You
Full Name*

First NameLast Name
City*

City

Zip Code
State/province*
State

CityState

Zip Code
Country*
Phone Number*
E-mail*
example@example.com
What is your title?*
Are you a licensed/registered practitioner? *
What type of licensed or registered practitioner are you?*
Do you have an active license?*

YesNo
Which states/provinces?

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewan
If you operate a medical practice, do you currently practice telemedicine in the states where you’re licensed?*
XWhat are the academic degrees you've earned?
What are the academic degrees and licenses you've earned? (1 per line please)*
What are your licensure credentials?
Are you trained as a (non-licensed) holistic nutrition practitioner? *
XIf so, what type?*
If so, what type?*

Functional Medicine PractitionerHealth Coach / Wellness CoachLife CoachNutritional Therapy Practitioner (NTP)Personal Trainer / Fitness Coach / Yoga TeacherSpiritual Guide / Energy HealerAnother type
Where did you receive your coaching/fitness/energy education, training and/or certifications? (1 per line please)*
Where did you receive your coaching/fitness/energy education, training and/or certifications?
Who recommended you to us? How did you hear about us?*
Have you had a legal chat or Power Hour with us before?*
Which one?*
About Your Business
Business Name*
Website or Landing Page*
Is your Business an LLC or S-Corp? If so, which one?*
What state/province is it registered in?*
If you’re a sole proprietor, are you thinking about forming a business entity soon?*
Which one?*
Do you currently have a medical practice?*
What state is it registered in?*

Street Address

Street Address Line 2

CityState

Zip Code
What state/province is it registered in?*
Do you currently have a (separate) coaching practice?*
What state is it registered in?*

Street Address

Street Address Line 2

CityState

Zip Code
How long have you been in business?*
What industry are you in?*
Who do you serve?*
As you expand your reach, what services would you like to provide?*
As you expand your reach, what services would you like to provide (if you're legally allowed to do so)?*

Medical practice in states where you are (or plan to be) licensedSelf-study / self-paced options (video or audio courses, DIY products, etc.)Group educational courses (group calls & interaction)Hybrid programs (group calls & interaction, accountability 1-on-1 calls at beginning/end)1-on-1 or personalized programs across state lines (coaching)Other (retreats, 1-day live events, etc.)Not sure yet
XWould you like to practice functional medicine, if permitted in your state?
XIf so, what kind?*
If so, what kind?*

Lab testingPersonalized protocols or recommendationsSupplementsAnother Type
Do you operate locally, virtually or both?*
Where You Are Legally
Have you gotten any legal advice recently? (For better or for worse!)*
What advice did you get?*
Are you currently using any legal documents for your clients, website or team?*
Which ones?*

Informed Consent Form (for patients - used by licensed medical practitioners only)HIPAA Notice of Privacy Practices (for patients - used by licensed medical practitioners only)HIPAA Medical Records Release Form (for patients - used by licensed medical practitioners only)Website Documents (Website Disclaimer, Terms & Conditions, Privacy Policy)Legal Starter Kit #1 for 1-on-1 Clients (contains Client Agreement - for 1-on-1 clients - used by coaches only)Legal Starter Kit #2 for Group Programs and Online Courses (contains Terms of Use - for group programs enrolled through website, self-study products)Legal Starter Kit #3 for Small Groups & Masterminds (contains Client Agreement for Small Groups & Masterminds - for hybrid programs, small groups enrolled through discovery calls, memberships - used by coaches only)Other
XWhich ones?*
If "other" please specify:*
Where did you get them?*

From an attorneyFrom a legal serviceFrom a friendI wrote them myselfOther
Do you use any of these marketing tools in your business?*
Do you use any of these marketing tools in your business?*

I don't use any of theseFree opt in giftFree webinars / seminarsGuest expert interviewsPodcast hostSocial mediaOther
Do you currently have insurance for yourself and your business?*
Do you currently have insurance?*

I don't have insuranceMedical malpractice insuranceCoaching insuranceOther types of insurance
Your Questions
What are you looking for?*

I want clarity about how to legally protect my business.I want to better understand the laws that affect me.I have a specific question.I need something else.
What is your main legal question? Why are you coming to us right now?*
What’s important about solving this legal need right now? How will it help you?*
What is the approximate time frame that you would hope to have a solution to this legal need?*
Legal services are an important investment in your business, but with DIY legal templates or payment plans, legal protection can be more affordable than you may think. When presented with your options, are you prepared to make a financial decision to move forward?*
Please share more of your thoughts and concerns. *
Would you like to receive free legal tips, offers and business insights via email from Lisa?*

Yes, I love free legal information!No thanks I don't want free legal tips.
I look forward to connecting with you soon!

Once you submit this Prep Sheet, you'll receive a copy of your response, and will be directed to the checkout page where you can complete your purchase. After you've made your purchase, watch an email to arrive with the link to schedule your call and a receipt.
Here’s to getting legally covered!

With Legal Love™,

Lisa Fraley, JD, CHHC, AADP

Legal Coach®, Attorney, Speaker & #1 Best Selling Author
Lisa Fraley Legal Coach LLC

Easy legal steps for entrepreneurs and small business owners - with lots of Legal Love™.
Get free legal tips, DIY legal templates and online legal courses at lisafraley.com.
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About You

About Your Business

Where You Are Legally

Your Questions