First Name *

Last Name *

Email *

Phone *

Which best describes you? *

Practice owner (clinician)

Practice owner (non-clinician)

Partner / co-owner

Office manager or staff

Practice Type: *

Functional or integrative medicine

Hormone therapy, testosterone, or menopause clinic

Medical weight loss

Longevity or wellness membership practice

Cash-based chiropractic

Cash-based physical therapy

Direct primary care or concierge medicine

Medical spa with treatment programs

How does your practice get paid? *

Entirely cash-pay

Mostly cash-pay, some insurance

Mostly insurance, some cash

Entirely insurance

What is your current monthly practice revenue? *

Pre-launch / under 1 year

Under $25K per month

$25K – $50K per month

$50K – $100K per month

$100K+ per month

How much are you currently investing in marketing (online and offline)? *

$0 – $1,000 per month

$1,000 – $2,500 per month

$2,500 – $5,000 per month

$5,000+ per month

Where do your new patients come from today? (checkboxes — pick all that apply) *

Referrals from patients or other providers

Google search / SEO

Paid ads — running now

Paid ads — tried in the past, stopped

Social media / content

Walk-ins and local reputation

I understand I'm applying for a 45-minute Flywheel Diagnostic with Flywheel Clinic, and I plan on keeping my appointment to the best of my ability (you'll choose a date/time on the next page). *

Yes

No