Practice Planning Questionnaire

Plan the practice you want to build

Think through your goals, your business model, and where you could use support.
Your Vision
Where are you in the process of starting a practice?

Other
What do you want your practice to make possible? Choose up to three.

Other
Three years from now, what would make this practice a success for you?
Think about the care you provide, what you earn, how you spend your time, and what you want to do differently from your current work.
What size practice would you like to build?
Are you building this practice on your own or with business partners? Business partners share ownership, rather than working as employees.
Have you agreed on ownership, responsibilities, and how decisions will be made?
What role would you like to have as the practice develops?

Other
The Care You Want to Provide
What is your professional background? Select all that apply.

Other
Who do you want your practice to serve? Select all that apply.

Other
What services do you want to offer? Select all that apply.

Other
Where do you plan to provide care?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How do you plan to provide care?

Other
Making the Business Work for You
What would a sustainable work schedule look like for you?
Estimates are fine. Leave any answer blank if you’re not sure.
Total working hours per week
Include patient care, documentation, administration, supervision, and business management.
Hours of direct patient care per week
This is part of your total working hours above.
Weeks off per year
Include vacations and holidays.
What annual personal income would you like the practice to provide? After business expenses, before personal taxes. This is your income, not total practice revenue.
How do you expect patients to pay for care? Select all that apply.

Other
Where are you in the insurance credentialing and contracting process? Select all that apply.
Do you have your contracted reimbursement rates in writing?
Which insurance tasks would you like help with? Select all that apply.
What financial preparation have you done? Select all that apply.

Other
Optional estimates:
Funding available for startup:
Optional
Months you could cover business expenses and personal income needs while revenue builds:
Optional
Where do you expect your first patients to come from? Select all that apply.

Other
Turning Your Plans Into Action
What have you already put in place? Select all that apply.
When would you like to launch or take your next major step?
Where would help make the biggest difference? Choose up to three.

Other
How would you like to approach the work? Choose one.
Have you set a budget for professional support? Optional.
Anything else you want us to understand about your plans?
Let's Send You Your Answers
Your Name

First NameLast Name
Email
example@example.com
Practice Name or Website (Optional)
Should be Empty:

Plan the practice you want to build

Your Vision

The Care You Want to Provide

Making the Business Work for You

Turning Your Plans Into Action

Let's Send You Your Answers