AdminPractice Registration Form - Draft example

1- How did you find this practice?
2- What was the reason for leaving the previous practice?
3- Why did you choose this practice?
4- What are the treatments and services you would be interested in?
5- From time to time, practices and Clinicians make discounts available for certain treatments. Would you be interested in finding out when these offers are available?
6- What can we improve further / any other comments?