New Client Intake
Please fill out the information below. We use this information to set up your account and create your first campaign.
Provider's Name
*
First Name
Last Name
Office Name
*
Office Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Cell Phone Number
*
-
Area Code
Phone Number
Website
*
Facebook Page Link
*
Instagram Link
Are you part of a particular practice management company or coaching program?
Ex. BPA, Integrity, TRP...
Where Do We Send The Lead Email or Text Notifications to: (can list multiple sources)
*
frontdesk@example.com;
CA's Name
*
Name of person following up with leads.
Average Patient Lifetime Value
*
National Average For Chiropractic Patient is $1200
Of the popular Google searches please check all that apply to your office.
*
Pediatric
Gonstead Technique
Y-Strap Adjustments
Walk-Ins Accepted
Activator Method
Thompson Technique
Prenatal
Other
Would you like to use our AI Booking feature?
*
Yes
No
AI CA FAQS
This is what will allow the bot to follow up and book leads more effectively and accurately.
What do you want the name of your AI CA to be?
*
Is there a specific booking link you would want the AI CA to send? (leave blank if you want to use the ChiroCandy App Calendar)
How long does the initial appointment take?
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How much does treatment cost?
*
What are some follow up questions you would like the AI CA to ask (these are questions that your team asks during the follow up process)
*
Is there any specific information about your office that you want the bot to know?
*
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Campaign Details
We're going to use our best judgment for targeting, but you know your area/niche better than us.
Type Of Campaign
*
Facebook/Instagram Ads
Google Ads
TikTok Ads
Database Reactivation
Daily Ad Spend Budget
*
$30
$35
$40
$45
$50
Other
Daily Ad Spend
We recommend at LEAST $30/day for optimal results
Niche
*
Chiropractic
Knee
Neuropathy
Decompression
Thyroid
Shoulder
Diabetes
Weight Loss
Other
"Offer" Price
*
Free
$27
$47
Other
Included in Offer
*
Exam
X-Rays
Initial Treatment
First Adjustment
Consult
Nerve Scan
30 Min Massage
Other
Audience Location?(Example: 10 mile radius from office? Include or exclude specific zip codes?)
*
How far do people drive to see you? Any specific zip codes we should target/avoid?
Demographics You Want to Reach
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Women
Men
Both
Target Age Range
*
Ex: 35-64; 25-55:
Any other comments regarding the campaign?
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A2P 10DLC SMS Verification
Please answer the following questions as it is registered with your state. We will use the information below to verify the phone number used for SMS.
Authorized Representative
*
First Name
Last Name
Job Title
*
Ex: Owner
Year Founded?
*
Legal Organization Name
*
Is the address your business is registered under the same as the office address?
*
Yes
No
Legal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Entity Type
*
Please Select
501-c3 Non-Profit
LLC
Sole Proprietorship
Partnership
Co-operative
EIN
*
Submit
Should be Empty: