Name *

First Name

Last Name

Phone

(###)

###

####

How many hours per week do you spend on administrative tasks (notes, scheduling, billing)? *

0-5 hours per week

6-10 hours per week

11-15 hours per week

16-20 hours per week

More than 20 hours per week

How often do you work on practice-related tasks outside normal business hours? *

Never - I maintain strict boundaries

Occasionally (1-2 times per month)

Weekly - usually 1-3 hours on weekends

Most evenings - 1-2 hours after dinner

Daily - evenings and weekends regularly

How confident are you in your practice's financial health and cash flow? *

Very confident - I have clear systems and predictable income

Mostly confident - occasional uncertainty

Somewhat confident - I get by but worry sometimes

Often uncertain - money stress affects my sleep

Very uncertain - financial anxiety is constant

How often do scheduling issues or client communication interrupt your personal time? *

Never - I have strict boundaries and systems

Rarely - maybe once a month

Sometimes - few times per month

Weekly - clients know they can reach me anytime

Daily - I feel constantly available to clients

How predictable is your client flow and schedule filling? *

Very predictable - steady waitlist and consistent referrals

Mostly predictable - occasional gaps but manageable

Somewhat unpredictable - alternates between busy and slow

Very unpredictable - feast or famine cycles

Extremely unpredictable - constant worry about filling slots

How satisfied are you with your practice's growth and professional development? *

Very satisfied - achieving goals and growing strategically

Mostly satisfied - steady progress toward goals

Neutral - maintaining status quo

Somewhat frustrated - feeling stuck or plateaued

Very frustrated - far from where I want to be

How connected do you feel to other professionals for support and consultation? *

Very connected - strong network and regular consultation

Mostly connected - good relationships with some colleagues

Somewhat connected - occasional professional interactions

Minimally connected - mostly working in isolation

Very isolated - feeling like I'm figuring everything out alone

What's your biggest operational challenge right now? *

Administrative overwhelm and time management

Financial uncertainty

Client scheduling and communication boundaries

Marketing and consistent client flow

Professional isolation and growth stagnation

All of the above