Administrative information

*Which system do you use for maintaining your clinical records?

SimplePractice

TheraNest

TherapyNotes

Other digital or paper system

*What company covers your malpractice insurance?

*Please provide your malpractice policy number

If anyone assists you with administering your practice (eg scheduling, billing, insurance submission), list assistant’s name, email address and phone number

*Office arrangement

Provided as part of a group practice

Rental or lease

Own

Provide the name and email address of the leaseholder

How did you hear about TheraClosure?

Administrative information about your practice