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Alabama
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Private Practice Consultation Questionnaire
Private
Practice
Consultation
Questionnaire
Full Name
*
Please type your full name.
Credentials:
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E-mail
*
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Phone
*
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Business Name
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Business Address
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Website (if applicable)
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Facebook or other social media page (if applicable)
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Reason for consultation (mark all that apply)
Billing/Insurance/Credentialing
Leaving a group practice
Starting a private practice
Marketing/branding
Practice management (organization, documentation, operations, etc.)
Feedback on current website, marketing materials, office space, etc.
Expanding an existing practice
Other
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Other (please describe):
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Which reason above is top priority?
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Please provide any relevant details for any items your marked above
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