New Client Setup Form

Name *

First

Last

Practice phone *

Personal Cell Phone *

Best way to contact you if your VA is sick *

Work email
Phone call on personal cell
Personal email
Text on personal cell

Email *

Your website *

Your Facebook Page and/or Instagram Profile

We would love to share and promote your services and programs on our social media.

Practice Address *

Address Line 1

Address Line 2

City

State

Zip Code

Personal Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Choose an address where packages can be accepted or left. We may send you occasional fun surprises. 🙂

Save and Resume Later

Do you currently have a referral tracking document?

Yes
No
I have one, but would like to improve it!

Where does your referral tracking document live?

Google Drive
Excel Spreadsheet
Another software

What software program are you using to track referrals?

Clinician Specialties

Please add detailed info on each clinician's specialties and the populations they work with. Alternatively, you can upload a document with that info below.

Upload Clinician Specialty Document

Click or drag a file to this area to upload.

Call Script

Please share with us the call script you would like your VA to use with all new callers. Be as detailed as possible. You can also upload a call script document below.

Upload Call Script Document

Click or drag a file to this area to upload.

Info on Fees and Sliding Scale

Please include detailed info on your private pay fees and sliding scale (if you have one) for all clinicians.

Directions to Your Office & Google Maps link

Please share detailed directions to your office that we can pass along to new clients before their first appointment. You can also include a link to your location on Google Maps (optional).

Do you currently have a clear setup process for new clients?

Yes
No
I have one, but would like to improve it!

Client Setup Process Steps

Please share detailed info about all the steps you want us to walk people through when they become a new client.

Or upload your client setup process workflow document here.

Click or drag a file to this area to upload.

Local Referrals

Please share contact info for any local referrals you often recommend.

Or upload your local referral document here.

Click or drag a file to this area to upload.

Save and Resume Later

Therapist Contact Info

If you have a group practice, please give us your therapists' phone numbers, extensions and email addresses.

What email software do you use? Please also share the email you will use for your VA. *

For example: Hushmail, Gmail (Google Workspace), etc.

Do you need help configuring an email address for your VA? *

Yes
No
Maybe

What EHR do you use? *

SimplePractice
TherapyNotes
Something Else

What phone system do you use? *

For example: phone.com, TalkRoute, Google Voice, etc.

Do you need help configuring your phone system for your VA? *

Yes
No
Maybe

Anything else?

Use this box to share any other info you'd like us to have at this point.

We are excited to start supporting your practice!

Ready to get more done & have more fun?