Assessment Strategy Call Intake Form

The more specific you are, the more precise the strategy I can deliver in our time together.

There are no wrong answers. Only a good use of the next 10 minutes before we meet.

Step 01

About your practice

The basics, so I know exactly who I'm preparing for.

First name*Please add your first name.

Last name*Please add your last name.

Email address*Please add a valid email address.

Phone number

Practice name*Please add your practice name.

City, state*Please add your location.

Years in practice* Please choose a range.

Practice type*

Solo practice (I am the sole provider) Solo owner with associates or hygienists Multi-provider group practice DSO-affiliated or partnership model

Please choose your practice type.

Step 02

Your primary goal for this session

This is where the strategy comes from. Be specific.

What is the single most important thing you want to walk away with after our session?* "Clarity on how to launch Botox" is more useful than "a plan."

Please share the outcome you want.

What is the biggest obstacle, question, or decision you are currently sitting with?* Be completely honest. The more specific the problem, the more targeted the strategy.

Please share what you're facing.

What does success look like for you in the next 90 days?*

Please describe your 90-day win.

Step 03

Strategic context

Where you are today, so we start in the right place.

Have you taken any steps toward adding Botox or aesthetic services to your practice?

No. I am in early research and exploration. Yes. I have completed or scheduled Botox training/certification. Yes. I have started offering Botox but need a growth strategy. I am exploring this as part of a broader practice expansion, not Botox specifically.

What is your team's current awareness of or buy-in to this idea?

My team does not know yet. I am still evaluating. I have mentioned it casually but nothing formal. My team is aware and engaged with the idea. My team has concerns or resistance I need to navigate.

On a scale of 1 to 5, how urgent is this decision for you right now? 1 = Exploring with no timeline. 5 = I need a clear path within the next 30 days.

Step 04

Anything else I should know

Optional, and often the most useful part.

Is there anything specific you want to make sure we cover, or anything you want me to know before we begin? This is your space. Use it.

Step 05

Review & confirm

Take one last look. Tap "Edit" to change anything.

I confirm my answers are accurate, and I'm submitting at least 24 hours before my scheduled session.