Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like help with setting production and collection goals in which to base the daily schedule
*
Yes
No
What is your retention rate in your office?
*
Would you like help creating a yearly Budget for the Practice?
*
Yes
No
Are you happy with the number of new patients you are currently getting monthly?
*
Yes
No
Are you happy with your current online reputation?
*
Yes
No
How confident are you that your employee policy manual is up to date and current according to California employment Law?
*
Would you benefit from help with employee wage and hours, including meals and rest breaks, AWS, overtime laws and time keeping?
*
Yes
No
What is your current Stress Level as a practice owner?
*
Extremely High
Moderately High
Low
Anything you would like to add?
*
Submit
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