Therapist Interest Therapist Survey Contact Information First Name * Last Name * Company Name * Title * Phone Number * (xxx) xxx-xxxx Email Address * Accountability System Do you already provide a daily accountability method for clients to check in with others? Yes No What are your biggest business challenges? (click all that apply) Not enough clients Too many clients Collecting payment Low revenue Too little time Slow client progress What interests you most about the Take24 service? Making more money Increasing the number of clients Reducing the time it takes clients to make change Improving the efficiency of your time What payment model is best to charge for the Take24 services? Clients pay Take24 directly in addition to paying you directly You pay Take24 directly, and you DO increase client fees You pay Take24 directly, and you DO NOT increase your client fees Other Therapy/Coaching/Advisory Practice In which primary area do you provide services? Marriage couples counseling Mental health counseling (i.e. anxiety, depression) Addiction counseling (i.e. substance abuse, overeating, sex) Executive coaching Athletic coaching Financial planning Other How many clients do you see monthly? 1-15 16-30 31-45 46+ How many more clients could you take on? How long do your clients typically stay with you? 1-2 months 3-6 months 7-12 months 13-24 months Greater than 24 months How often do you see your clients? Daily Weekly Every 2 weeks Every 4 weeks Every 6 weeks As needed How many clients pay with insurance? None 25% or less 26% - 50% 51%-75% 76%-100% What is your fee for a 60-minute session? How many therapists are in your office? Are you HIPAA compliant? Yes we are today No, but we will be in the near future No and we don't have plans to be Not sure or not applicable Check the box below to confirm you are not a robot and allow form submission.
