Michael Cox - Making MŪVs Mail - New Intake Form Submitted!
This document is a completed new‑client intake form for Michael Cox, owner of Insight Chiropractic Inc., submitted on 12 March 2025. It captures comprehensive contact information (personal and office emails, phone numbers, Instagram handle, office address, and preferred area codes), communication preferences (call forwarding to office line, text and email notifications for leads), and the name of the primary outreach staff (Lindsey Jarmakowicz). The form records legal business details (registered name Insight Chiropractic Inc., EIN 933‑377‑273) and practice location. Service‑related data include the current new‑patient exam offering (Spinal Health Screening/Chiropractic Exam Consult/Health History Relief Treatment) with a full price of $260, a list of core modalities (various chiropractic techniques, shockwave therapy, flexion distraction, spinal decompression, cupping, Class IV), and additional therapies (hydro‑therapy massage, KT‑taping, nerve flossing, therapeutic and lymphatic drainage massages, Thai massage, deep‑tissue massage). Insurance acceptance is listed (Aetna, Cigna, Florida Blue). Marketing information comprises the practice website (1Insightchiro.com), Instagram handle (@1insightchiro), and a link to Google reviews showing 13 five‑star reviews. The client’s expectations for a “10/10” experience are a high show‑rate with shows costing under $75, while a low show‑rate costing $175 would be unsatisfactory. Photo consent is granted. The form also notes the number of new patients seen in the chiropractor’s career (≈3,500) and includes placeholders for a business logo and professional headshot.
Topics
Comprehensive Contact & Communication Preferences
All personal and office email addresses, phone numbers, preferred area codes, Instagram handle, and notification settings for leads and bookings.
Legal Business Identity and Tax Information
Registered business name (Insight Chiropractic Inc.), EIN/Tax ID, and office address as used for tax filings.
Service Portfolio, Pricing, and Patient Experience Expectations
Details of the new‑patient exam, full price ($260), core chiropractic modalities, additional therapies, and the client’s criteria for a satisfactory (under $75 per show) versus unsatisfactory (over $175 per show) experience.
Insurance Acceptance and Billing Parameters
List of accepted insurance plans (Aetna, Cigna, Florida Blue) indicating the practice’s payer mix.
Marketing Presence and Reputation Metrics
Website URL, Instagram handle, Google review link, and count of 13 five‑star reviews, reflecting online visibility and patient satisfaction.
Outreach Personnel and Lead Management
Name of the primary outreach staff (Lindsey Jarmakowicz) and the routing of GoHighLevel calls and lead notifications.
Professional Visual Assets and Consent
Photo consent granted and placeholders for business logo and professional headshot uploads.