Pre Onboarding Intake Form

Please Fill Out This Information PRIOR To Your Onboarding Call.

Business Profile

Business Name - exactly as it appears on their EIN *

Business EIN *

Business Structure *

Business Website *

Business Logo - upload JPG/PNG

Business Profile (Continued)

Business Address - exactly as it appears on their EIN *

City *

State *

Zip code *

Business Phone *

Business Email *

General Settings

Hours of Operation

Preferred Area Code - for outgoing messages *

Backup Area Code - for outgoing messages *

Where you would like to receive SMS notifications *

Where you would like to receive email notifications *

Identify main point of contact for account management - usually Front Desk, Practice Manager, etc

Point of Contact

Point of Contact Phone

Point of Contact Email

Website Information

If this is confusing or difficult to find, please reach out to our team for assistance

Website domain - this is where the website is hosted. Examples are GoDaddy, CloudFlare, NameCheap

You will need to grant access to our team.

Please Grant Access to evan.maxwell@capnur.com

If your site was built by a 3rd party, please provide contact information and we will reach out

Contact Name

Contact Email

Contact Phone Number