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Office Questions - One Person Fills out Per Office

(Required for all offices in the C3 Program, Connected Community or VIP 1:1 Coaching)

Complete this form ONCE per office. The C.A. or D.C that does the stats should be the one to answer these.

This quick online form collects general details + previous stats about your office so I can better support your team’s systems, communication & growth.

✅ Only one team member needs to complete this on behalf of your office.
✅ Questions include office operations, communication systems, and social media details.

 

📌Fill out when you have at least  5 Minutes to truly focus & have access to stats because this MUST be completed in one sitting & does not save your information until you submit.

Click below to begin.

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Question 1 of 13

List ALL employees at your office (including associates & support staff) and their title:

Question 2 of 13

Are you currently working with another Coaching Program (Example: The Wealthy Practitioner, Close for Chiro etc) or marketing/social media company (Example: Contente, Upper Cervical Marketing). If yes,  list the companies.  If no, type N/A.

Question 3 of 13

What is your office Instagram Handle and how many followers do you currently have?  Who all posts on social media?

Question 4 of 13

What is your 2026 Office Collection Goal and where are you at year to date ( ex: goal is 250k this year and we have collected 50k so far to date)

Question 5 of 13

What Software to you use (Example: Jane, Atlas etc) for Patient scheduling & payments?

Question 6 of 13

Do you have an Open Adjustment Area, a combo of Open area + Private rooms or Private rooms only?

Question 7 of 13

How long is your average patient visit (how long does their adjustment take)?

Question 8 of 13

Average number of Patient visits a day?

Question 9 of 13

What is your normal New Patient Procedure & Price. Explain IN DETAIL here if you do everything in one day including Care plan recommendations, do you have a Day 1 (NP) and Day 2 procedure (ROF) or something else? What does your New Patient Rate include (X-rays, nerve scans, decomposition, adjustment etc)? 

Question 10 of 13

Do you invite the Spouse or a "Support System" person to either the New Patient Visit or Report Of Findings & if yes, what wording do you normally use? If you do not invite the Spouse/Support System write N/A

Question 11 of 13

Are you in or out of network with Insurance?

A

In Network

B

Out of Network & Patient Submits

C

Out of Network & We Submit for Patient

Question 12 of 13

What is your average Care plan recommendations and cost, then list all the ways a patient can accept Care & Pay. (Example: 34 visits over 3 months = $2500. We do not offer a Pay Per Visit plan  so they can either 1) Prepay & save 20% 2) Make monthly payments & save 10% or 3) apply for Care Credit without a discount) 

Question 13 of 13

List EVERY source of income at your office in addition to adjustments. (Example: supplements, cold laser, decompression etc) 

Confirm and Submit