Practice Strategy Session Application
Thank you for your interest in working with Divine Billing & Credentialing Services and The Insurance Plug Academy. This application helps us better understand your practice, current challenges, and goals before our session. By completing this form, you'll help ensure our time together is focused, productive, and tailored to your specific needs. During your Practice Strategy Session, we'll discuss your current stage of practice development, insurance and credentialing goals, billing and revenue concerns, operational challenges, and potential next steps to support your growth. Please complete all questions thoroughly. Once your application is submitted and reviewed, you will receive information regarding scheduling and payment for your strategy session. We look forward to learning more about your practice and helping you move forward with confidence.
BASIC INFORMATION
Name
*
First Name
Last Name
Email
*
example@example.com
Practice Name
*
State(s) of Practice
*
Phone Number
*
-
Area Code
Phone Number
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Are you a Solo or Group Practice?
*
Are you currently seeing clients?
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Yes
No
Do you accept insurance
*
Yes
No
Are you currently credentialied?
*
Yes
No
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Goals
What is your biggest challenge right now?
*
What do you hope to accomplish during this strategy session?
*
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Service Interest
Check all that apply
*
Credentialing
Billing Services
Revenue Strategy
Practice Practice Setup
Insurance Education
Team Training
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Budget Readiness
Are you looking for
*
Education only
Consulting
Ongoing services
Not sure yet
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Commitment Questions
If a solution is identified during our session, are you prepared to invest in implementing it?
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Yes
Maybe
No
How soon are you hoping to implement a solution?
*
Immediately
Within 30 days
Withing 60-90 days
Just exploring options
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Success Outcome Questions
What would make this strategy session successful for you?
*
Is there anything else you'd like us to know before the session?
*
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Agreement Section
Please confirm the following:
I understand this is a paid Practice Strategy Session.
*
I understand
I understand Practice Strategy Sessions are designed to provide personalized guidance and recommendations based on your unique goals and challenges.
*
I understand
I understand this session is designed to provide guidance, recommendations, and next steps based on my specific needs.
*
I understand
I understand that completing this application does not guarantee acceptance for ongoing consulting or services.
*
I understand
I understand that payment is required prior to scheduling my session.
*
I understand
I understand all session fees are non-refundable..
*
I understand
I understand missed appointments or cancellations made with less than 24 hours' notice will result in forfeiture of the session fee.
*
I understand
I understand that there is only one reschedule allowed with a 24-hour notice.
*
I understand
I understand to ensure a productive session, all applicants must complete the application, submit payment, and select an appointment time..
*
I understand
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Reserve My Session
Reserve My Session
Please Note: Practice Appointments must be scheduled at least 48 hours in advance. Sessions are available Tuesday-Thursday 9am-2pm.
*
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My Products
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Practice Strategy Session
$295.00
$
295.00
Credit Card
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Signature
*
Submit
Submit
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