LaunchPad Onboarding Form

Practice Information

Practice Name*

Practice Website*

Last 4 digits of DEA number*

Please specify physician's last name associated with the DEA number

New Patient Appointment Phone*

New patient appointment phone number for digital leads

Appointment Request Email*

Monitored email address for form fill outs for appointments

Patient Advocate Phone

If you have a different number for a patient advocate, enter that here

Review Response Email*

This email address will receive notices on profile reviews and any private feedback submitted by a patient

Physician Information

Add Physician

List Primary & Secondary Specialty(s)	List of conditions and treatments	Physician Headshots	Actions

There are no Physicians.

Location Information

List location(s)

If practicing at more than one location, list primary location first

Location Address	Appointment phone number	Clinic Hours	Actions

There are no Locations.

List holiday closures*

Other Holidays

Interior/Exterior Location Photos

Drop files here or

Max. file size: 128 MB.

Average annual patient value

Provide the name of your Practice Management software and any other patient communication tools you currently use (appointment reminders, reviews, etc)

Phone

This field is for validation purposes and should be left unchanged.

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PROGRAMS BUNDLED FOR SUCCESS.

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LaunchPad Onboarding

Practice Information

Physician Information

Location Information