Let's get in touch.

Note: For questions that ask you to enter a dollar amount, enter whole numbers only and leave off the dollar sign ($) and commas, e.g. $10,000.01 would be entered as 10000.

First Name *

Last Name *

Practice Name *

Email *

Phone (Format: 4045551234) *

City *

State *

Annual Practice Collections (total if multiple locations) * Less than $1,500,000$1,500,000 to $2,000,000$2,000,000 to $2,500,000More than $2,500,000

If you were referred by someone, who was it?

What's your pain point when it comes to money? *

Are you a current Pro-Fi Client? * YesNo

How many locations does your practice have?

How many chairs do you have? If more than one location, list an average.

How many doctors, including the owner?

How many new patients do you get each month?

Would you like to share high level balance and cash flow information for a more substantive conversation? YesNo

What is your personal liquidity? (Cash/Brokerage)

What is the estimated value of your 401(k) / IRA retirement assets? Less than $500,000$500,000-$2,000,000Over $2,000,000

What is the estimated value of your home, if you own a home?

If you own any other real estate, what is the additional combined value?

Do you have a mortgage? YesNo

If Yes, what is the estimated balance on your mortgage?

Do you have Student Loans? YesNo

If Yes, what is the estimated balance on your student loans?

Do you have credit card debt? YesNoN/A

If Yes, what is the total balance?

If Yes, what is your total monthly payment on credit card debt?

Do you have other personal debt? YesNo

If Yes, what type of debt?

If Yes, what is the estimated balance on this other debt?

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