Onboarding Form
Clinic Name
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Clinic Owners Full Name
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Clinic Owners Phone Number
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Clinic Owners Email
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Clinic Email
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Clinic Phone Number
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Clinic Physical Address Description (Ej. We are to the right side of the 123 Main Street intersection, next to the Walgreens)
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List of insurance plans (aclarar cual plan medico necesita referido):
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What offer would you like to offer in your ads? Example: $[price] Evaluation, Exam, X-Rays, Report of Findings & Personalized Treatment Plan.
Time Zone
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Legal Business / Practice Name (As mentioned on CP 575 Form) IMPORTANT
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Legal Business Type
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What is your EIN number?
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ATH Móvil Business Name
What is your clinic's website URL?
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Total price if initial visit wasn't discounted
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Average Treatment Plan Price
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How long is the 1st visit for new patients at your practice? (15, 30, 45, 60 mins)
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How does your initial visit process look like? (Example: Day 1 - Consultation, Exam, X-Ray | Day 2 - ROF, Treatment)
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Number + Email for Appt/Lead Notifications
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Number to contact in case of any urgent communication (cell phone)?
Submit
