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New Practice Registration Form

New Practice Registration Form

Fill out this short form. This will assist in training your AI chat assistant on your practice.
29Questions
  • 1
    Who should we contact if we have questions or need clarification during setup?
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  • 2
    The best phone number to reach the contact person.
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  • 3
    Email of the contact person
    Email Verified

    The verification code has been sent to some@email.com
    Please check your mailbox and paste the code below to complete verification

    Didn't receive verification code?or
    Receiving the email may take a few minutes, thank you for your patience!
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  • 4
    This ensures your chat assistant correctly identifies your practice and speaks on your behalf using the proper name.
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  • 5
    ChiroChatPro indexes your entire website to learn your services, hours, location, links, and policies.
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  • 6
    The physical location of the clinic.
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 7
    Any additional information for the chat assistant? (It's OK, if there isn't any additional information needed).
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  • 8
    The chatbot is designed to guide patients to the fastest, most effective booking option for your practice.
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  • 9
    Fill this out ONLY if the information does NOT appear on your website.
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  • 10
    Fill this out ONLY if the information does NOT appear on your website.
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  • 11
    A patient that does NOT have an appointment.
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  • 12
    Any additional information for the chat assistant? (It's OK, if there isn't any additional information needed).
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    Enter
  • 13
    Choose which plan.
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  • 14
    Answer ONLY if this information IS NOT on your website.
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    Enter
  • 15
    Answer ONLY if this information IS NOT on your website.
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    Enter
  • 16
    Answer ONLY if this information IS NOT on your website.
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  • 17
    Answer ONLY if this information IS NOT on your website.
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    Enter
  • 18
    Choose the best answer when it comes to how your clinic handles x-rays.
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  • 19
    Any additional information for the chat assistant? (It's OK, if there isn't any additional information needed).
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  • 20
    Choose the best option (This ensures the chat assistant matches your practices voice and patient experience).
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  • 21
    We brand the chat assistant to match your website. (Do this ONLY if your logo DOES NOT appear on your website).
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
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  • 22
    Any additional information for the chat assistant? (It's OK, if there isn't any additional information needed).
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    Enter
  • 23
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  • 24
    The chat assistant relies on your website as its primary knowledge source.
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  • 25
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    Enter
  • 26

    ChiroChatPro – Terms and Conditions

    Effective Date: [January 1, 2026]

    These Terms of Service (“Terms”) govern the use of ChiroChatPro (“Service”), operated by ChiroChatPro (“Company,” “we,” “our,” or “us”). By accessing or using the Service, the chiropractic clinic or practice (“Client,” “you,” or “your”) agrees to these Terms.

    If you do not agree, do not use the Service.


    1. Service Description

    ChiroChatPro is a fully managed, informational and navigational chat assistant designed exclusively for chiropractic practices. The Service is intended to assist website visitors by answering common questions, guiding them to relevant content, and directing them to scheduling or contact options available on the Client’s website.

    The Service:

    Is trained on public-facing website content provided by or accessible from the Client
    Acts as a digital receptionist, not a clinical tool
    Does not replace clinic staff or licensed professionals

    2. No Medical Advice

    ChiroChatPro does not provide medical advice.

    The Service:

    Does not diagnose conditions
    Does not recommend treatments
    Does not provide clinical opinions
    Does not replace a licensed chiropractor or healthcare professional
    All medical questions, concerns, or treatment decisions must be handled directly by the Client or a licensed healthcare provider.


    3. HIPAA & Data Handling

    ChiroChatPro is designed to be HIPAA-conscious.

    The Service:

    Does not store or retain protected health information (PHI)
    Does not access electronic health records (EHRs)
    Does not collect or maintain patient medical records
    Operates solely using public or client-provided informational content
    Clients are responsible for ensuring their website content complies with applicable privacy and healthcare regulations.


    4. Client Responsibilities

    The Client agrees to:

    Maintain accurate, current, and up-to-date website content
    Notify ChiroChatPro of material changes that may affect assistant accuracy
    Review of the assistant’s behavior upon deployment
    Not relying on the Service for clinical decision-making
    Ensure the Service aligns with the clinic’s policies and applicable laws
    Chiro Chat Pro is not responsible for inaccuracies resulting from outdated or incorrect client-provided content.


    5. Ownership & Intellectual Property

    Clients retain ownership of their website content, branding, and materials.
    ChiroChatPro retains ownership of the Service, system architecture, training framework, workflows, and proprietary technology.
    Clients are granted a limited, non-exclusive right to use the Service during an active subscription.
    Clients may not copy, resell, reverse engineer, or repurpose the Service.

    6. No Guarantee of Results

    Chiro Chat Pro does not guarantee:

    Increased patient bookings
    Revenue growth
    Website conversion rates
    Specific business outcomes
    Results vary based on website traffic, clinic responsiveness, content quality, and other external factors.


    7. Subscription, Trial, and Cancellation

    ChiroChatPro may offer a free trial period.
    No payment is required during the trial unless otherwise stated.
    Subscriptions are billed monthly unless canceled.
    Clients may cancel at any time.
    Upon cancellation, the assistant will be removed from the Client’s website and access terminated.
    No refunds are provided for partial billing periods unless required by law.


    8. Limitation of Liability

    To the fullest extent permitted by law:

    ChiroChatPro is provided “as-is”
    We are not liable for missed appointments, lost opportunities, or business interruption
    We are not liable for indirect, incidental, or consequential damages
    Total liability shall not exceed the amount paid by the Client in the preceding three (3) months

    9. Indemnification

    The Client agrees to indemnify and hold harmless ChiroChatPro from claims arising out of:

    Misuse of the Service
    Inaccurate or unlawful website content
    Violations of healthcare, privacy, or advertising regulations
    Client representations to patients or third parties

    10. Acceptable Use

    Clients may not:

    Use the Service for unlawful purposes
    Attempt to extract system logic or data
    Misrepresent the Service as providing medical advice
    Interfere with or abuse the Service

    11. Service Modifications

    ChiroChatPro reserves the right to:

    Modify or improve the Service
    Update these Terms as needed
    Discontinue features with reasonable notice
    Continued use constitutes acceptance of updated Terms.


    12. Governing Law

    These Terms are governed by the laws of the State of [Georgia], without regard to conflict-of-law principles.


    13. Contact Information

    For questions regarding these Terms, contact:
    [info@chirochatpro.com]

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  • 27
    Agree to the terms and conditions
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  • 28
    The session should answer all your questions to see if Chiro Chat Pro is right for your practice.
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  • 29
    Add your signature to allow us to get started on your chat assistant
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