Quote Generation Questionnaire

Name*

First Last

Phone*

Email*

Company Name*

What services are you interested in?*

Number of Therapist Users*

Number of Admin Users*

Current number of children seen per month

Current number of services per month

In what states do you provide services*

County/Counties*

Please list the county/counties you reside. If more than 1 county please comma separate them ie. Allegheny, Washington, Beaver

Select Disciplines*

Will you be using the Zoom Video Integration*

The Zoom integration requires a HIPAA compliant Zoom account, with individual users.

When are you looking to start using your new system?*

How do you want to enter current or past client information*

Will you require additional training?*

Included: Admin: 1 training prior to launch, and 2 training after launch Therapist: 1 training prior to launch, 1 training after launch

Subscriptions are charged on the first of the month for that month. Set-up and Data Migration fees are charged at sign-up.