Client Intake Questionnaire

First name*

Last name*

Practice name*

Email*

Mobile phone number*

What are your primary programs/goals with working with NeuPTtech's MVP Program?*

Do you work with any other business coaches?*

Yes

If yes, which business coaches do you work with and how often?

How many personnel/staff work at your practice?*

How often do you meet with your entire team?*

How often do you meet with your leadership team?*

Do you have a clinical education program? If yes how many DPT students do you have on average each year?*

What is your office/clinic square footage?*

How many treatment centers do you have? *

What is your Visit Volume per week on average?*

What is your Net Revenue per visit on average?*

What is your Net Cost per visit on average?*

How much should your staff therapists generate in revenue vs their compensation? What is the max % you can afford to pay them (based on revenue, NOT billed amount)?

What patient capacity could you handle?*

After 12 months in the NeuPTtech MVP Program, what would you consider a success?*