First Name
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Last Name
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Demographics
Main service provided?
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Private Acupuncture
Community Acupuncture
Other
What number of practitioners offer what service?
What style of acupuncture do you use?
What other services do you provide?
What type of practitioner are you?
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Clinic Owner - Solo Practitioner
Clinic Owner - Multi-Practitioner
Contractor
Other
How many clinic locations do you have?
1
2
3
4
5
6
7
8
No elements found. Consider changing the search query.
List is empty.
Number of Acupuncture Practitioners (not including admin/reception staff)
1
2
3
4
5
6
7
8
9
10
10+
No elements found. Consider changing the search query.
List is empty.
Which one suits you best?
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Full Time - 24 hours per week or more
Part Time - less than 24 hours per week
New Clinic - just starting out
Do You Have Admin Staff?
Yes
No
If yes, how many admin staff does your business have?
How much do you make annually in revenue?
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$
Happy Charting
What was your biggest pain point you were looking to solve before you found HC?
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What were you doing inefficiently or ineffectively before Happy Charting?
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How much time did it take to finish 1 chart before Happy Charting?
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How much time does it take to finish 1 chart with Happy Charting?
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How many patients do you see on average per week?
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How much time has Happy Charting saved you in time spent charting, on average per week?
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If Happy Charting hasn't saved you time, what has it done for you?
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How did Happy Charting most positively impact your business?
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How did you hear about Happy Charting?
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Non-Charting Software
Do you use a scheduling software?
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Yes
No
If yes, what is the name of the scheduling software?
Do you submit insurance?
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Yes
No
Who is insurance billed from?
From Patient
From Practitioner
Both
Neither
Unsure
What insurance companies do you allow billing to, if any?
Do you use an Insurance Billing Software?
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Yes
No
If yes, please state the name of the insurance software/service provider you use:
Do you only use paper forms?
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Yes
No
Do you allow patients to fill out forms from your website?
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Yes
No
If you use software to allow patients to fill out forms online, please name it here.
If you don't use a forms software, but do allow patients to fill it out online, please write how:
Final Section
Feedback/Improvement
Best email to receive your reward
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