New User Intake Form

Premium User Intake form
Business Information

Tell us about your company.
Legal Business Name
DBA if different
Business Address

Street Address

Street Address Line 2

CityState

Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email
example@example.com
Website URL
Ai Details

A Few details about your new team member.
Male or Female?
New team member's name?
Point of Contact

Let us know who we will communicate with.
Primary Contact Name

First NameLast Name
Primary Contact Email
example@example.com
Primary Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Media & Digital Intake Channels
Which platforms currently receive customer/patient inquiries, booking requests, or messages?
Where is your website hosted and do you have access?
Can you give access to any/all of selections above?
Extra Details
Any Business Info to Train
Details that are unique or specific to your office ex.( Services offered, skills, years of experience, etc).
Phone System & Routing Setup

Use this section to capture routing and access details.
Does your phone system allowing call forwarding and routing rules?
Do you have access or can give access to setup necessary rules?
Technical Info

Use this section for technical access and setup contacts.
What system(s) do you currently use for scheduling, patient/customer records, lead management, or communications?

Other
List all programs/softwares specifically and how you use them?
Who should we contact for technical access, integrations, account permissions, or system setup questions and phone forwarding/routing rules?
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Compliance and Agreements
IMPORTANT: This Agreement automatically renews monthly unless canceled before expiration. Billing will begin automatically using the payment method on file. We Require a 30 day written notice for cancelation to deactivate all processes currently in use and to get your system back to how it was.
Signature
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Premium User Intake form

Business Information

Ai Details

Point of Contact

Social Media & Digital Intake Channels

Extra Details

Phone System & Routing Setup

Technical Info

Compliance and Agreements