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Built to Launch: Vision to Venture Application

Let's Get to Know Your Practice

This short application helps us understand your goals and see whether this program is the right fit for where you are and where you want to go.

Click the button below to start.

Start

Section 1:

Contact Information

Question 2 of 20

Full Name:

Question 3 of 20

Email Address:

Question 4 of 20

Phone Number:

Question 5 of 20

Practice Name and Address:

Section 2:

About Your Practice

Question 7 of 20

How many years have you been in practice?

Question 8 of 20

How many active Vision Therapy patients do you currently have?

Question 9 of 20

What services do you currently offer?

(Select all that apply)
A

Primary eye care

B

In-office Vision Therapy

C

Telehealth

D

Digital/remote programs

E

Other

Question 10 of 20

How many VT evaluations do you perform per month (on average)?

Question 11 of 20

Roughly what percentage of VT evaluations convert to therapy?

A

0-25%

B

26-50%

C

51-75%

D

76-100%

E

Not sure

Question 12 of 20

What digital tools or platforms are you currently using, if any?

(e.g., Zoom, HTS, NeuroVisual Trainer, none)

Section 3:

Why You're Exploring Digital VT

Question 14 of 20

What's motivating you to explore a digital VT program?

Question 15 of 20

What impact would a digital VT program have on your practice or patients?

(e.g., increase access, serve waitlist, create new revenue, etc.)

Question 16 of 20

Do you have someone in your practice who will help lead this?

A

Yes - a VT Director, therapist, or office manager

B

Maybe - still deciding

C

No - I plan to lead it myself

Section 4:

Capacity + Commitment

Question 18 of 20

Do you have 2-4 hours per week available to dedicate to this program?

A

Yes

B

Not right now

C

Unsure

Question 19 of 20

If accepted, are you prepared to make the $5,000 investment to join the program?

A

Yes

B

I'd like to explore payment options

C

I'm still gathering information

Question 20 of 20

Is there anything else you'd like us to know about your goals or current challenges?

Confirm and Submit