Complete the online application by 5/1/2024. If selected to participate, successful applicants will be notified as we review them. They are considered in order of receipt and once we've reached our maximum number of Practices, we will no longer be able to accept applications.

For Which Program Tier Are You Applying?

Xccelerator
OnRamp
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Section I: Practice Leader Information

Full Name *

Company Name

Email *

Phone *

City *

State *

Postal code *

Instagram Account

Section II: Business Specific

Total Years Of Business Operation *

Number of Providers *

How Involved are You in the Day-To-Day? *

0-2 hours - minimal time on day-to-day activities, more on strategic planning and vision.
3-5 hours - moderately involved, dedicating a few hours to oversee and make decisions on daily operations.
6-8 hours - actively participating in and managing the majority of activities.
9+ hours - fully immersed.
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If you have a website please provide it below.

Company Stage *

Ideation
Early Stages
Growth
Expansion/Innovation
Renewal/ Decline
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What is Your Current Company Structure?

Sole Proprietorship
MSO
LLC
PLLC
Corporation
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Total Revenue Generated Last Year? *

Average Ticket Value

Provide A Brief Company Overview: (Limit To 3-6 Sentences) *

Provide a Brief Description of Why You are Interested in Growing Your Practice Through our Xccelerator Program.

Section III: Proficiency Scale

Please Select Your Top 5 Areas Where You Feel You Need The Most Help From Our Expert Advisors.

Legal: Business Structure / Contracts / Ownership
Legal: Clinical Documentation / GFE / Malpractice
HR /Onboarding / Compensation
Accounting / Taxes
Financial Planning / KPIs
Digital Marketing / Social Media
Practice Operations / Patient Experience
Technology / Systems / Automation/ AI
Risk Management / Protecting Your Investment
Medical Director / In-Practice Compliance (Charting, Documentation)
Events / Promotions / Driving Revenue
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Tech & Software: List & Briefly Explain The Current Systems You're Utilizing Day-to-Day (If Applicable).

Do You Currently Work with Any of the Following Types of Consultants or Advisors?

Attorney on Retainer
Social Media / Marketing Firm
Practice Growth Consultant
Financial Planner
HR / Recruiter
Business Coach
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If We Could Eliminate Your Biggest Pain Point(s) at Xccelerator, What Would Those Be? *

Section IV: Basic Practice Demographics

Which of the Following Apply To Your Practice?

Online Booking
Memberships
Cancellation Policy
eCommerce Options (Gift Cards, Packages)
Prepayments / Patient Wallet
Industry Reward Programs (Aspire, Alle, etc.)
Member of a GPO or Buying Group
Practice Located Inside Another Business
GFEs Can Be Done Every Day by Someone on Staff
Medical Director is Onsite Full Time or Part Time
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What Are Your Current Service Offerings?

Filler / Toxin
Biostimulators & Regenerative Options
Lasers / Energy Devices
Aesthetician/Spa Services
GLP-1 Weightloss
Body Contouring
PDO Threads
IV Therapy
Hormone Replacement
Functional Medicine
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Select All Provider Licensure Levels That Apply For Your Staff

MD or DO
Nurse Practitioner / CRNA
Physicians Associate
Registered Nurse
Aesthetician or CLT
Medical Assistant or LPN
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Section V: Next Steps

We Will Match Your Preferences with Our Advisors. Once Complete, We May Ask You For More Information to Better Equip the Advisors to Help You. Is This Okay?

Yes, I am happy to provide what you need as long as it is kept private
There are some things I am unwilling to share, and I'm okay changing my sessions if needed
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Each Practice Can Bring Up to Two Additional Team Members at a Discounted Rate. Do You Anticipate Bringing Others? If So, How Many?

I commit to actively participating in all sessions and events from [5/17/2024] to [05/19/2024]. I understand that consistent attendance is crucial for maximizing the benefits of the program, and failure to meet commitments may result in dismissal without a refund.

I Agree

I Do Not Agree

If I am selected for Xccelerator, I understand that I will have up to 3 business days to confirm my registration. If I am unable to do so, the meeting organizers reserve the write to offer my spot to another applicant.

I Agree

I Do Not Agree

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.