Personal Info

First Name *

Last Name *

Email *

Cell Phone *

Business Info

Business Name *

Business Email Address *

Business Website *

Business Facebook *

Business Instagram *

Existing Clinic Phone Number *

What would you like to name your AI assistant? (Note: Make sure to use an actual name) *

Clinic Address *

Simple Location Address. (How would you describe your address?)

What are your hours of operation? *

Parking Instructions *

Can you accommodate Spanish patients? *

Yes

Where would you like to receive email notifications for interested customers that must be called? (Please list all)

Where would you like to receive sms notifications for interested customers that must be called? (Please list all)

Please list your staff and their positions *

Other

New Phone Number Info

Cell phone carriers have introduced new mandates to prevent spam. To comply, your phone number must be registered (read more in our overview document here.)

The number of texts you can send will be limited until your number is verified, and the verification process can take up to 3 weeks. Small errors can prevent verification, so please be sure to follow our guidelines carefully so we can get you up and running as soon as possible!

Please fill in the following information below so we can register your number and maximize results.

Legal Business Name (This must match the address on registration documents EXACTLY. Small differences like hyphens or spaces can cause rejection and delays. Please take care to provide the correct information.) *

Legal Business Address (This must match the address on your business documents EXACTLY. Small differences like hyphens or spaces can cause rejection and delays. Please take care to provide the correct information.) *

Business Registration ID Type *

USA: Employer Identification Number (EIN)

USA: DUNS Number (Dun & Bradstreet)

Canada: Canadian Corporation Number (CCN)

Other

Is your business registered? *

Yes

Business Registration Number (US corporations must provide an EIN [unless you are a sole proprietorship] This is formatted as XX-XXXXXXX; CA corporations must provide a CCN with 9 digit number) *

Complete Onboarding Survey