Owner Intake Form | The MedSpa Society

1

About You

So we can route your intake correctly and follow up if we have questions.

Practice Name *

Your Name *

Email Address *

Phone (optional)

2

Practice Overview

The foundation of how we approach your audit.

Location

Years in Operation

Services Currently Offered *

List everything you offer — injectables, laser, skin treatments, body, wellness, etc.

Non-Clinical Staff Members & Their Roles *

Include each person's title and a brief description of their role. Front desk, patient coordinator, practice manager, etc.

Average Weekly Patient Volume

Does your practice offer remote or virtual patient touchpoints?

Phone consultations, virtual appointments, social media DM responses, text-based inquiries, etc.

Yes — we actively communicate with patients remotely

Limited — we respond when patients initiate

No — patient contact is in-person only

Describe how you communicate with patients remotely (optional)

How do new patients most commonly make first contact?

Select all that apply.

Phone call

Online booking

Social media DM

Referral

Email inquiry

Walk-in

Any context on how those first contacts typically go? (optional)

3

The Current Patient Experience

Be honest here. This is what the audit will be testing.

How would you describe the patient experience your practice currently delivers — in your own words? *

What do patients most commonly compliment about the non-clinical experience?

Think reviews, verbal feedback, and direct comments you've received.

Where do you sense friction, inconsistency, or gaps in how patients are communicated with or cared for? *

This is the most important question in this section. Be specific.

Have you ever lost a patient you believe left because of a non-clinical interaction?

Describe what happened if so. If not applicable, write N/A.

How consistent is the patient experience across different staff members?

Very consistent — patients get the same experience regardless of who they interact with

Generally consistent — minor variation but nothing concerning

Inconsistent — it noticeably depends on who the patient interacts with

Unsure — I don't have enough visibility into day-to-day interactions

Anything to add about consistency across your team? (optional)

4

Your Team

Your honest assessment of the people delivering the patient experience.

🔒

Your responses are confidential. This information is only seen by The MedSpa Society consultant working on your engagement. You do not need to use full names if you'd prefer not to — initials, roles, or descriptions work fine.

For each non-clinical staff member, describe their strengths and any concerns you have about their patient interaction style *

Be candid. Vague assessments ("everyone is great") don't help anyone — including your staff.

Is there a staff member you have reservations about that you have not yet addressed directly?

Yes

No — I address concerns directly with my team

Describe the situation if comfortable (optional)

Understanding this helps us know where to look during the audit.

Has any patient ever asked for or specifically avoided a particular staff member?

Yes — patients have requested a specific staff member

Yes — a patient has avoided or complained about a specific staff member

Both have happened

Not that I'm aware of

Describe the context if comfortable (optional)

How would you describe the overall culture and morale of your non-clinical team?

Excellent — cohesive, motivated, and supportive of each other

Generally good — some friction but functioning well

Mixed — there are dynamics or tensions I'm aware of

Concerning — there are issues I haven't fully resolved

Anything else about team culture or dynamics you'd like us to understand? (optional)

5

Your Expectations

What you want out of this engagement — and whether you're prepared to act on what it surfaces.

What is the single most important thing you want this engagement to change or improve? *

Are you prepared to make staffing changes if the engagement surfaces a staff member who is not suited for patient-facing work?

Yes — I am willing to make changes if the data supports it

Probably — I'd want to exhaust coaching options first

Unsure — I find this difficult and want to discuss it

No — staffing changes are not something I'm open to right now

Anything you want to add about this? (optional)

What does a successful outcome look like to you at the end of this engagement? *

OwnerIntake Form

About You

Practice Overview

The Current Patient Experience

Your Team

Your Expectations

Intake Received

Owner
Intake Form