Uncommon Practices - Practice Analysis Questionnaire - 800 940 0185

Please fill out this questionnaire and submit it.
We will contact you once you submit your responses, to schedule
your free Practice Analysis Assessment.

1. First name

2. Last name

3. Email address

4. What is your phone number?

5. City and state where your practice is located

7. Do You Have (or are thinking of starting) a Solo or Group Practice?

8. What area(s) of specialization does your practice engage in?

11. What are your specific goals for your practice at this time?

12. If you have any other services other than therapy, please list them here:

13. What are your top three referrals sources?

14. What percentage of your clients use insurance for your services?

15. What is your website URL?

16. If you do have a website, how many referrals does it generate on average every month?

17. Has your website been optimized for any of the following? Please check all that apply

18. What are the greatest challenges you are currently facing in your practice?

19. How difficult has it been for you to get answers or solutions to these challenges?

20. What would be the consequences in your life if you don't overcome these challenges?

21. Do you feel there are any specific issues based on the location of your practice?

22. Anything else you'd like to add that would help us understand your practice even better?

Thank you!
Be sure to click on the 'CLICK HERE to SUBMIT YOUR QUESTIONS for Feedback' button
below which will submit your responses to us.
You should receive an email which will allow you to schedule a time
to receive your Free Practice Analysis Assessment by phone. 
If you have any questions, please call us at 800 940 0185
or email us at info@uncommonpractices.com