First Name

Last Name

Email *

Do you want to have Auto Answer Ai answer your phone?

Yes

No

If you do want Auto Answer AI choose which level

Do you want Auto Support Ai chat widget on your website?

Yes

No

Do you want us to add in a 12 month newsletter automation for you?

Yes

No

Choose your monthly newsletter specialty

General Information

Are your clinic hours fixed? *

Yes

No

What are your operating hours?

If no: Do your hours vary by day or provider?

Can I walk in for an appointment, or do I need to schedule in advance? *

Walk-ins Accepted

Appointment Only

Do you accept insurance? *

Yes

No

Which insurance plans do you accept?

Do you offer self-pay discounts or alternative payment options?

Do you offer virtual or telehealth consultations? *

Yes

No

Can I book an appointment online? *

Yes

No

Where can I schedule?

Do I need to bring anything specific for my first visit? *

Yes

No

What should I bring?

How long does the first visit usually last?

Do you have a cancellation or rescheduling policy? *

Yes

No

Do you offer financing or payment plans? *

Yes

No

What are the available options?

Are there any discounts or package deals available? *

Yes

No

What types of discounts do you offer?

How can I contact the clinic after hours?

What should I do if I have a medical emergency?

Do you provide care for all age groups? *

Yes

No

What are your age restrictions?

Is your clinic wheelchair accessible? *

Yes

No

Does your staff speak multiple languages? *

Yes

No

Which languages?

How do you ensure my personal and medical information stays private?

Is there usually a long wait to get an appointment?

What can I expect during my first visit?

Website

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