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Welcome Medallion Level Member!

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Welcome Medallion Level Member! THERAPIST RESOURCE GUIDE FOR BEGINNING A SUCCESSFUL PRACTICE Courtesy of UI/BI/CHI/DAI - Alumni Associations and the IAHP As an alumnus of The Upledger Institute, The Barral Institute, The Chikly Institute, The D’Ambrogio Institute, and the International Alliance of Healthcare Educators, you are part of a global network that advocates international leadership in education. Through your alumni association, you have a powerful ally to support your goals of building a successful practice. We have over 25 years of experience in offering quality education, backed by a diverse support structure. Recognizing that healing arts practitioners typically are more comfortable working with their clients vs. business development plans, we created an easy-to-use Therapist Resource Guide to help you reach your practice goals. After all, the more organized your practice is, the more focused you can be as a manual therapist. By completing the sections in the order that they are presented, you’ll be able to write action steps that will lead to enhanced visibility and the growth of your practice. Further, we provided forms that you may wish to use to organize your back office. You deserve to be rewarded for your skills, time and education; we are honored to be a part of your success! ©2014 International Association of Healthcare Practitioners.
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Page 1: Welcome Medallion Level Member!

Welcome Medallion Level Member!

THERAPIST RESOURCE GUIDE FOR BEGINNING A SUCCESSFUL PRACTICE

Courtesy of UI/BI/CHI/DAI - Alumni Associations and the IAHP

As an alumnus of The Upledger Institute, The Barral Institute, The Chikly Institute, The D’Ambrogio Institute, and the International Alliance of Healthcare Educators, you are part of a global network that advocates international leadership in education. Through your alumni association, you have a powerful ally to support your goals of building a successful practice. We have over 25 years of experience in offering quality education, backed by a diverse support structure. Recognizing that healing arts practitioners typically are more comfortable working with their clients vs. business development plans, we created an easy-to-use Therapist Resource Guide to help you reach your practice goals. After all, the more organized your practice is, the more focused you can be as a manual therapist. By completing the sections in the order that they are presented, you’ll be able to write action steps that will lead to enhanced visibility and the growth of your practice. Further, we provided forms that you may wish to use to organize your back office. You deserve to be rewarded for your skills, time and education; we are honored to be a part of your success!

©2014 International Association of Healthcare Practitioners.

Page 2: Welcome Medallion Level Member!

A. Establish practice goals. What size practice do you wish to build in the next year/two years/5 years? You may wish to define the size of the practice as the number of clients, or amount of revenue to be generated. Are you a solo practitioner, and wish to remain as such, or be part of a multi-therapist practice? Do you want to learn more modalities or become a specialist for a particular patient base or condition, for example, pediatrics or TMJ disorders? Do you wish to have one or multiple office locations? Your answers should be specific and realistic. _______________________________________________________________

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B. Analyze your current practice. What are your professional titles/certifications/specializations? _______________________________________________________________

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What are the highlights of your experience - basic training and continued educa-tion, number of years practicing, related employment or affiliations, unique skills? What differentiates you from your competition? _______________________________________________________________

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Page 3: Welcome Medallion Level Member!

How many clients do you currently see on a daily/weekly/monthly basis? _______________________________________________________________

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What percentage of your clients has regularly scheduled appointments? _______________________________________________________________

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What are your clients’ most common health complaints? _______________________________________________________________

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What techniques/modalities do your clients most often request? _______________________________________________________________

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Do you help your clients understand their conditions and why you are using certain techniques to address them? _______________________________________________________________

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Do you give your clients suggestions for continuing progress at home? _______________________________________________________________

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Page 4: Welcome Medallion Level Member!

What are your clients’ demographics - age, sex, income level, geographic location? _______________________________________________________________

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How would you describe your ideal client? _______________________________________________________________

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How do you get new clients? Do your clients/family/friends/ colleagues refer clients? Do you have business cards, a website, and/or brochures? Do you advertise? _______________________________________________________________

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Do you work out of your own office, someone else's space, or go see clients in their locations? If clients come to you, is your space clean, professional, and inviting? Do you have a receptionist that is cordial and helpful to your clients? _______________________________________________________________

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Do you begin your appointments on time? _______________________________________________________________

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If you go to your clients, do you arrive on time, dress professionally and bring equipment/supplies that are the best you can provide? _______________________________________________________________

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Page 5: Welcome Medallion Level Member!

What do clients like best about your practice? _______________________________________________________________

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What do clients like least about your practice? _______________________________________________________________

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How much do you charge - is the rate consistent with others, above or below the average? _______________________________________________________________

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Do you belong to and/or participate in any professional associations? _______________________________________________________________

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Are you active in the community? Have you been recognized for your work in the community? _______________________________________________________________

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©2014 International Association of Healthcare Practitioners.

Page 6: Welcome Medallion Level Member!

Who is your competition? _______________________________________________________________

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How do you handle patient/client complaints? _______________________________________________________________

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C. Recognize problems and opportunities. After analyzing your practice, problems or weaknesses are often clear. Likewise, opportunities become apparent. You’ll want to make a list of both. _______________________________________________________________

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Problems Sample problems or weaknesses may relate to: needing further training in a technique/modality that addresses complaints you often hear from your clients; refreshing your office; improving your marketing efforts; and/or other concerns. _______________________________________________________________

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_______________________________________________________________ ©2014 International Association of Healthcare Practitioners.

Page 7: Welcome Medallion Level Member!

Opportunities Opportunities might relate to promoting special skill sets; minimal competition in your geographic/demographic area; actively asking for referrals; and/or other advantages. _______________________________________________________________

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D. Set your objectives. Now is the time to write down specific objectives that you wish to accomplish. What problems are you going to address and when? What opportunities are you going to take advantage of and when? Your objectives should be specific, measurable, and time-sensitive. Example: 1. Increase awareness of my practice through electronic communication

channels, i.e. website, online advertising, social media such as Facebook, Twitter, email and mobile marketing. Implement all efforts by year end.

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©2014 International Association of Healthcare Practitioners.

Page 8: Welcome Medallion Level Member!

E. Develop Strategies. For each objective noted above, you’ll want to develop a strategy for accomplishing that task. For example: Objective #1: Increase awareness of my practice through electronic communication channels, i.e. website, online advertising, e-newsletters, social media such as facebook, twitter, email and mobile marketing, etc. Strategies: 1. Review and update my website so that it is user-friendly, adequately

describes my expertise and services, provides clients with tips to stay healthy, etc.

2. Complete my Therapist Profile on the IAHP site. (A terrific benefit of the

Medallion Membership is the ability to feature all of the unique attributes you have, [as well as speak of your individual education through study courses and more], through the Profile hosted on the IAHP site. This benefit is included in your annual dues and is greatly encouraged.)

3. Create a monthly e-newsletter to send to clients, friends, colleagues. 4. Establish a presence on social media networking sites such as Facebook and

LinkedIn 5. Start Tweeting health tips to clients and referral sources 6. Investigate the use of email and mobile marketing to confirm appointments,

promote the practice, highlight health events and news, offer specials 7. More… When developing strategies, you may wish to keep this list of marketing tools in mind: • Website • Therapist Profile on IAHP • Develop a Referral Program • Ask for testimonials and use in all marketing efforts • Be listed in community directories, in print and online • Facebook, LinkedIn, Pinterest, Twitter and other social media options • Direct mail campaigns – postcards, letters, brochures • Email campaigns (consider service providers such as Constant Contact, I • Contact, Vertical Response, and others. Compare pricing and services) • Send out a press release to the community papers to announce significant

achievements, awards or involvements • Write an article for consumer and/or trade publications and post it on your

website and circulate it to clients, colleagues and friends after it is published ©2014 International Association of Healthcare Practitioners.

Page 9: Welcome Medallion Level Member!

• Seek out interview opportunities in print or broadcast channels • Seek out speaking engagements at clubs, Chamber of Commerce,

community and church groups • Participate in community Health and Wellness Events • Become active in neighborhood and community organizations • Develop relationships with local businesses that serve your potential clients

such as sporting good and health food stores. Ask if you can leave or post your business card or brochures.

• Distribute personalized advertising specialties • Advertise in community and health papers • Offer gift certificates or special discount packages • Give gift certificates to charity auctions • Follow up your service with phone calls • Holiday parties • Co-advertise or co-partner with like-minded practitioners or related

businesses F. Create a budget. After you have developed your list of strategies, you will need to investigate the costs and create a budget for the year. The cost of your efforts will likely determine your timing for implementation. Keep in mind that electronic communications are generally much lower cost activities than direct mail or advertising and can be quickly and easily integrated into your plan.

©2014 International Association of Healthcare Practitioners.

Page 10: Welcome Medallion Level Member!

G. Track your progress. • How did your new patient/client hear of you? • If he/she was a referral, by whom? • What part of your plan is reaching the most prospects? • Are you more in demand to educate your community? • How many of your new clients now see you regularly? • What is the monetary benefit you derived from your plan? • Did you stay on schedule in implementing your plan? • Are you meeting your goals? • What strategies would you do again? • What strategies would you not do again? _______________________________________________________________

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H. Client forms and information To help you get started, we have included copies of a few forms that may be useful in building your practice. This includes client information forms, patient release and consent forms, etc. For practice building, it is very important to customize these forms…adding your name, logo and other information that brands you as a practitioner. Good Luck to you and feel free to contact us if we can be of assistance as you build you successful practice!

©2014 International Association of Healthcare Practitioners.

Page 11: Welcome Medallion Level Member!

Client Information

NAME:______________________________________________________DATE:___________________ (PLEASE PRINT) ADDRESS:___________________________________________________________________________ CITY:_______________________________________________________STATE:_______ZIP:________ PHONE - HOME:_____________________WORK:__________________CELL:____________________ May we leave v-mail messages on your home, cell or work numbers: ! Yes ! No May we leave message with spouse, partner or other persons (state name/relationship): ! Yes ! No ____________________________________________________________________________________ EMAIL ADDRESS: ____________________________________________________________________ DATE OF BIRTH:__________________________ MALE:_____ FEMALE:_____ (CIRCLE ONE): SINGLE WIDOWED DIVORCED HAVE A SPOUSE or PARTNER NAME OF SPOUSE OR PARTNER:______________________________________________________ IF REFERRED, BY WHOM:_____________________________________________________________ ( Patient / Therapist / Doctor - Name & Phone number ) EMPLOYER:___________________________________OCCUPATION:__________________________ ADDRESS:_______________________________________________________PHONE:_____________ Please be advised that Medicare will not pay for CranioSacral Therapy for the reason(s) noted: Description of Service(s): 97799 CranioSacral Therapy Reason(s) for Medicare’s denial: Not Covered Service. Describe the reason you have come here and the symptoms you are experiencing: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Date of injury or onset of illness: ___________________________________________________ What makes the problem worse: ___________________________________________________

What makes the problem better: ___________________________________________________

What other treatments have you received for this problem: ______________________________ _____________________________________________________________________________

(Please continue to next page)

©2014 International Association of Healthcare Practitioners.

Page 12: Welcome Medallion Level Member!

If accident, list type (auto, workers comp. personal injury, etc.): __________________________ _____________________________________________________________________________ List all prescription and non-prescription medications you are currently taking: _______________ _____________________________________________________________________________ List any allergies that you have: ___________________________________________________ _____________________________________________________________________________ List and date surgeries/hospitalizations: _____________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Additional Comments: ___________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

**Please Refrain From Wearing Perfume, Cologne or Other Scents**

Payment is required at the time of service and you are responsible for all fees.

Please provide 24 hours cancellation notice if you are unable to keep your appointment. If we are not notified 24 hours in advance, we will charge you for your missed appointment.

MY SIGNATURE CONFIRMS THAT I AM AWARE OF AND AGREE TO THE ABOVE.

SIGNATURE:_________________________________________________DATE:__________________ ********************************************************************************************* IF THE PATIENT IS UNDER 18, PLEASE COMPLETE THE FOLLOWING: NAME OF LEGAL PARENTS OR GUARDIAN: EMPLOYERS OF PARENTS/GUARDIAN: ___________________ OCCUPATION: EMPLOYER ADDRESS: ____________________________________ PHONE:

©2014 International Association of Healthcare Practitioners.

Page 13: Welcome Medallion Level Member!

Physical Therapy Intake FormPersonal Information

History

Complaint

Do You Have Any of the Following Today? (Check All That Apply)

Name: ____________________________________________________ Date: _________________________________Address: _________________________________________________________________________________________Phone: ____________________________________________ Email: ________________________________________DOB: ______________________________________________ Sex: __________________________________________Who referred you: _________________________________________________________________________________

Exercise frequency: __________________________________ Exercise type(s): ______________________________Do you smoke? _______________ Have you ever smoked? _______________ How often?____________________Are you pregnant? ___________________ Do you have a pacemaker? _____________________________________Allergies: _________________________________________________________________________________________What medications are you currently using? ___________________________________________________________Previous complaints/surgeries: ______________________________________________________________________Previous diagnoses/medications: ____________________________________________________________________

What is your major complaint? ______________________________________________________________________Start Date: ____________________________ Possible cause: ____________________________________________Symptoms: _______________________________________________________________________________________Previous doctors seen for complaint: ________________________________________________________________Symptom-aggravating factors: ______________________________________________________________________Symptom-relieving factors: _________________________________________________________________________Time of day symptoms are best: _______________________ Time they are worst: __________________________Current duration of pain: q Intermittent q Constant q With certain motionsCurrent level of pain: q Mild q Moderate q Severe q ExcruciatingIs your pain getting better or worse?: ______________________ Have you had this injury before? ____________

q AIDS/HIVq Arthritisq Cancerq Diabetesq Hemophiliaq Lung Issuesq Stroke

q Anemiaq Asthmaq Chemical Dependencyq Epilepsyq High/Low Blood Pressureq Multiple Sclerosisq STD

q Anginaq Blood Clotsq Circulation Problemsq Eyes Infectionq Joint/Bone Infectionq Musculoskeletal Problemsq Tuberculosis

q Arteriosclerosisq Bone Infectionq Depressionq Heart Problemsq Liver Problemsq Pneumoniaq Urinary Infection

______________________________________________________ ____________________________ Signature Date

Mark Areas of Discomfort

©2014 International Association of Healthcare Practitioners.

Page 14: Welcome Medallion Level Member!

Birth History

Client’s Name: _________________________________ Date: _________________________ Form Completed By: ____________________________ Diagnosis: _____________________ Did mother: Yes No Have any infections/illness during pregnancy? ___ ___ Describe: _____________________ Have any shocks or unusual stress during pregnancy? ___ ___ Water break more than 24 hours before delivery? ___ ___ Develop toxemia/high blood pressure? ___ ___ If yes, when? _________________ Have any complications during delivery and/or labor? ___ ___ Mother’s age at delivery: _________________ Any miscarriages? ________ If so, how many? _______ If premature, how many weeks? __________ What was child’s birth weight? ___________ Child’s weight at discharge form hospital? _________ Apgar scores: 1 minute: __________ 5 minutes: __________ CHILD’S BIRTH Was or did child: Yes No Yes No Full term? ___ ___ Require Intensive Hospitalization? ___ ___ Premature? ___ ___ How Long? _____________ Cesarean section ___ ___ Prematurity ___ ___ Breech (feet first) ___ ___ Need respirator? ___ ___ Face Presentation ___ ___ How Long? ____________ Transverse (sideways) ___ ___ Small for gestational age? ___ ___ Have the cord wrapped around neck? ___ ___ Heart defect? ___ ___ Require forceps or vacuum extraction? ___ ___ Require exchange transfusion ? ___ ___ Have any birth injuries? ___ ___ Jaundiced? ___ ___ Describe: ______________ How long under lights? _______________ Require a fetal monitor? ___ ___ Have congenital abnormalities? ___ ___ Have insufficient oxygen? ___ ___ Have seizures? ___ ___ Cry right away? ___ ___ Have infection at birth? ___ ___ Have surgery as newborn? ___ ___ Have feeding problems as a newborn? ___ ___ Please provide additional information you may deem helpful (e.g. mother’s emotional state, family history, siblings, etc.): ________________________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

©2014 International Association of Healthcare Practitioners.

Page 15: Welcome Medallion Level Member!

Body Pain Indicator Chart

Patient’s Name:__________________________________________ Date: ______________________

Date of Birth: ________________________ Age: ________ Gender: Male q Female q

Use a pencil or pen to indicate the body areas where you are experiencing pain or discomfort.

Front Back

©2014 International Association of Healthcare Practitioners.

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PATIENT RELEASE AND CONSENT TO TREATMENT

I, ____________________________________, hereby request and consent to

treatment from ________________________________. I understand that my

treatment may require the provision of varied therapies including, but not limited to CranioSacral Therapy®, physical therapy, massage, other manual therapies,

acupuncture and counseling. I realize that the particular therapeutic outcomes of

these treatments, individually and jointly, cannot be predicted with certainty and

no guarantee is made regarding any particular result or outcome.

_____________________________________ _______________ Signature Date

©2014 International Association of Healthcare Practitioners.


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