Karisa Walsh - Making MŪVs Mail - New Intake Form Submitted!
This document is an Airtable‑generated new‑client intake form submitted on 9 January 2026 by Karisa Walsh of Viva Family Chiropractic. It captures comprehensive business and personal contact details (office and personal emails, phone numbers, office address), legal identifiers (legal business name, LLC status, EIN), and operational preferences (time zone, preferred area codes, call forwarding, notification channels). The form outlines the practice’s core services and pricing (new‑patient exam $150 plus $150 for full‑spine X‑rays, chiropractic modalities, tonal nervous‑system‑focused care) and provides marketing information (website, Instagram handle, Google review count, request for logo and headshot). It also records consent for photo use, preferences for outreach personnel, and notes on insurance (none accepted). Additional free‑text responses indicate the client’s expectations for a “10/10” experience (effective ads, support) and dissatisfaction triggers (lack of support).
Topics
Comprehensive Contact & Communication Preferences
All office and personal email addresses, phone numbers, preferred area codes, notification channels (text and email), and call‑forwarding preferences.
Legal Business Identity & Tax Information
Legal business name (Viva Family Chiropractic LLC), EIN/Tax ID, and confirmation of LLC status for registration of new GoHighLevel phone number.
Practice Location & Physical Address Details
Office street address, suite number, city, state, ZIP, and mapping links for the clinic location.
Service Portfolio and Pricing Structure
List of core services (diversified chiropractic, TRT only, tonal nervous‑system‑focused care), new‑patient exam components, and pricing ($150 exam + $150 full‑spine X‑rays).
Marketing Assets and Online Presence
Website URL, Instagram handle, request for logo and professional headshot, and Google review count (77 five‑star reviews).
Patient Outreach Personnel and Workflow
Name of primary outreach/follow‑up staff (Kari Skoglund) and preferences for phone forwarding to office line.
Insurance Acceptance and Billing Policy
Statement that the practice does not accept insurance, indicating a cash‑based model.
Consent for Media Use and Photo Uploads
Explicit consent for using uploaded photos/logo in marketing materials.