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Private Practice Launch Pre-Consult Questionnaire

Answer this form so I can understand your current stage, goals, and the type of support that will serve you best. This helps me recommend the coaching package that fits you and ensures our session is focused, productive, and tailored to your practice journey.
Full Name*

First NameLast Name
Contact Number
Please enter a valid phone number.
Email Address*
example@example.com
What state are you currently licensed in?*

Street Address

Street Address Line 2

CityState

Zip Code
What is your current license type?*

LMSWLCSWLPTLMFTPsychologistPre-licensed clinicianOther
If none of the choices apply, what is your current license type?
Where are you in your private practice journey?*

I have not started yet and need help from the beginningI am in early planning but have not launchedI recently launched and need support building structureI have an active practice but need guidance improving systems and direction
If you already have a practice, when did you start?
Briefly describe your practice status (where you are now).*
What is your desired launch or growth timeline?*

Within 3 monthsWithin 6 monthsAt the beginning of the yearAlready launched but need structureI am not sure
What are your top three goals for working together?*
What is motivating you to build or strengthen your practice at this time?*
Which of the following do you currently have?*

Business nameLLCEINNPIBusiness bank accountNone of the above
If you already have these items, share any questions or concerns.
Who do you feel called to serve?*
What specialties or client concerns interest you the most? (You may add all specialties you want.)*

TraumaAnxietyDepressionCouplesTeensIdentity workFaith based counsellingOther
In your own words, describe the practice you want to build.*
Do you already use an EHR or scheduling system?*

YesNo
If yes, which one?*
What systems or tools do you want to learn more about?*
What feels unclear, overwhelming, or confusing in this season?*
What kind of support helps you feel most successful?*

Clear step by step instructionsAccountabilityTemplates and toolsEncouragement and mindset supportStrategy and directionOther
Do you have any questions you want to discuss during the Strategy Session?*
Anything else you would like me to know before we meet?*
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Private Practice Launch Pre-Consult Questionnaire