Intake Form
Welcome and thank you for taking the time to answer all the questions. The information you share will provide clarity on the support you require.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Name
*
Website URL
Leave blank if you don't currently have a website
What services do you offer?
*
Occupational Therapy
Psychology
Podiatry
Speech Pathology
Physiotherapy
Dietetics
Coaching / Wellness programs
Counselling
Other
How many people make up your team
*
Solo Practitioner / Business Owner
2-5 team members
6+ team members
What tasks would you like your Free Range VA to complete for you?
*
Do you already have standard operating procedures for these tasks?
Please Select
Yes
No
What is your number one challenge when it comes to completing these tasks yourself? (eg. time, know-how)
Please state the top 3 business goals or priorities you would like your Free Range VA to contribute to.
Please note, your VA will not be liable for the achievement of your business goals.
Do you work with any of the following client types?
*
NDIS Participants
Work Cover Clients
TAC Clients
Victims of Crime Clients
Medicare Funded Clients
Private Health Insured Clients
None of the above
What practice management software do you use? (if applicable)
*
Splose
Halaxy
Cliniko
Nookal
CorePlus
None
Other
What email marketing software (CRM) do you use? (if applicable)
ActiveCampaign
MailChimp
MailerLite
None
Other
What is your ideal budget for virtual admin support
*
Please Select
$500 per month
$700 per month
$900 per month
Do you need the support of a Free Range VA in an ongoing capacity or for a one-off project?
*
One-off Project
Ongoing Support
Unsure
How soon do you need your Free Range VA to start?
*
For one-off projects - What is the timeframe you have for your one-off project?
What is your preferred communication method?
*
Email
Phone
Messenger App
Thank you, please press the submit button now.
Once you submit your form, I'll review your responses and reach out via email with your next steps.
Submit
Should be Empty: