Application
IMPORTANT: Please answer the questions below so we can help you determine if NewACUPatient$™ 2.0 is a good fit for you. I genuinely want an honest answer to every question because your success with NewACUPatient$™ 2.0 will depend on it. Your information will not be shared with anyone outside our organziation. I will get back to you within 24 hours or less (excluding weekends) with feedback from our evaluation. I look forward to hearing from you!
Business/Practice Name
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Your Name
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Email
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Phone
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Website
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What is your role in the business?
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Are you the key decision maker?
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Do you practice full-time?
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Please select one
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Select an option:
I am the business owner (the lease and electric bill is in my name)
I am an independent contractor (I rent a room(s) in someone else's clinic)
I am employed as a licensed acupuncturist at a clinic (I am a W2 employee)
What does your practice do/provide?
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Do you offer an in-person Free Consultation?
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Yes
No
Do you have a receptionist or front desk person answering the phones live during regular office hours?
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Yes
No
How many treatment rooms do you have?
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1
2
3
4
5
6
More than 6
Do you accept insurance?
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Yes
No
Do you accept credit cards?
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Yes
No
Do you have patient testimonials?
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Yes
No
What are your top 3 goals for the practice?
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What are your top 3 problems or struggles?
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Do you run online ads to drive traffic to your website? If so, what is your monthly ad spend?
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How often do you create and publish content?
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How many followers do you have on Facebook, Instagram and/or LinkedIn
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Do you have a good online reputation? (good or no online reputation count as 'good'.)
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Yes
No
What kind of marketing tools do you use at the moment?
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Are you financially prepared to invest in marketing your business?
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Yes
No
What kind of monthly budget do you have for scaling your practice?
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Why are you considering my team and I for this project?
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If we both agree that NewACUPatient$ 2.0 is a good fit for you, when are you looking to get started?
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