Insurance Wizard Not Sure What Coverage You Need? Start the MEDI Insurance Wizard We know that Insurance is daunting, and that’s why we’re here for you every step of the way. Step 1 of 4 - Contact Information 25% Please submit your contact information. This is where MEDI the Insurance Wizard will send your FREE TOTAL COVERAGE REPORT customized to your insurance needs.Your Name:* First Last Phone Number:*Email Address:* How Are You Currently Providing Your Services? Select The MOST Applicable Answer:* I am contracted for my services and do not own the medical spa/functional medicine clinic I own the medical spa/functional medicine practice and operate as an employee/officer I am opening one or more medical spa/functional medicine clinic When Is Your New Medical Spa/Functional Medicine Clinic Opening?* MM slash DD slash YYYY How Many Staff Will You Employ?*Will You Be Providing Payroll?* Yes No If You Are Contracted For Your Services, How Do You Recieve Payments?* I receive payments to my personal name I receive payments to a business I have incorporated Tell Us More About Your Profession: (Select Most Applicable)* I am a physician medical spa/functional medicine clinic owner I am a physician and I’m also the Medical Director I am not a physician and I contract a Medical Director What Is Your Profession?* Naturopathic Doctor Nurse Practitioner Registered Nurse LPN Medical Aesthetician Laser Technician Medical Assistant Other If Other, What Is Your Profession?* Select The Type Of Providers That Participate In Your Business And The Quantity:* Medical Directors Physicians Nurse Practioners Physician Assistants Massage Therapists Licensed Aestheticians Phlebotomists Medical Assistants Other Select The Type Of Providers That Will Participate In Your Business And The Quantity:* Medical Directors Physicians Nurse Practioners Physician Assistants Massage Therapists Licensed Aestheticians Phlebotomists Medical Assistants Other How Many Medical Directors Are On Your Staff?*Anticipated Number Of Medical Directors You Will Hire?*How Many Physicians Are On Your Staff?*Anticipated Number Of Physicians You Will Hire?*How Many Nurse Practioners Are On Your Staff?*Anticipated Number Of Nurse Practioners You Will Hire?*How Many Physician Assistants Are On Your Staff?*Anticipated Number Of Physician Assistants You Will Hire?*How Many Massage Therapists Are On Your Staff?*Anticipated Number Of Massage Therapists You Will Hire?*How Many Licensed Aestheticians Are On Your Staff?*Anticipated Number Of Licensed Aestheticians You Will Hire?*How Many Phlebotomists Are On Your Staff?*Anticipated Number Of Phlebotomists You Will Hire?*How Many Medical Assistants Are On Your Staff?*Anticipated Number Of Medical Assistants You Will Hire?*If Other, Please Specify Personnel & Number You Staff:*If Other, Please Specify Personnel & Number You Will Staff*Are All Personnel Licensed & Trained In Accordance With Applicable State and Federal Regulations For The Services They Provide?* Yes No If No, Please Explain (Short description)*How Do You Pay Service Providers That Participate In Your Business?* Employment Payroll Third Party Contractor(s) 1099 Both Are you the owner of the building(s) you are currently operating out of?* Yes No Do You Own Equipment, Computers, Devices, Machines, That Are Worth Over $10,000?* Yes No Do You Utilize A Laptop For Medical Service Related Work? Store Patient Files In The Cloud? Communicate With Patients Via Email, Text Or Voice Over Internet Phones (VOIP)?* Yes No Do You Handle Customer And Employee Data Like Credit Card Details & Personal Information? Accept Electronic Payments? Manage Website? Have Business Related Information Stored In The Cloud?* Yes No
