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Administrative information about your practice
*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
Office is owned by me or is in my home/apartment which IÂ own/rent
Provide the name and email address of the landlord (i.e., person/company you pay for your commercial office space)
How did you hear about TheraClosure? Please try to be specific, such as naming the specific webinar, podcast, media story, Â conference, or Google search
To go back, complete the form, return to Dashboard and click ENTER/UPDATE
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