Private Pay System™ Visibility Diagnostic: Intake Questionnaire

A paid ($97), diagnostic-first visibility report for private-pay therapy practices.

Clarity before effort. Sequence before execution.

Incomplete or vague responses may require clarification before the diagnostic is run.

(Where the PPS Visibility Diagnostic should be delivered)

Location(s) you serve

Practice / Business Model

Solo private practice

Small group practice

Advisory / service-based business serving therapists

Approximate % of private pay vs insurance:

Typical Session Fee Range:

Fee you wish you could confidently charge:

Average Weekly Caseload:

Approximate Annual Revenue Band

Under $150k

$150k–$300k

$300k–$600k

$600k–$1M

Over $1M

Right now, most new clients find you through (select up to two):

Referrals (clients / peers)

Directories (Psychology Today, etc.)

Google search / local SEO

Community / institutional relationships

Which of these feels most fragile or unpredictable right now?

If this source stopped producing new clients for 3 months, what would that realistically mean for your practice?

Who do you do your best work for today? Be specific.

This section surfaces the tensions PPS is designed to resolve.

Which of these feels most true right now?

I’m full but under-earning

I’m mostly private pay but visibility feels fragile

I’m panel-heavy and don’t see a clear exit path yet

I’m getting inquiries, but not the right-fit clients

Where do you feel you’re making the most costly marketing decisions right now?

Who I’m trying to serve

How I talk about the practice

Where I put time and money into visibility

Pricing, policies, or boundaries

This section helps determine whether PPS-level work is appropriate right now.

What are you seriously considering changing in the next 6–12 months? (check all that apply)

Fees or fee structure

Insurance participation

Niche or specialization

Hiring or scaling up

Scaling down or simplifying

Which best describes what you’re looking for right now?

I want someone to tell me what to post or do

I want help making better long-term decisions, even if that means changing course

If we both agree there is a clear path forward, are you prepared to invest time, attention, and money to implement changes over the next year?

Yes

This intake is used to assess whether a private-pay visibility system can realistically support the practice you want, and which decisions would need to change for that to happen.

You’ll receive your PPS Visibility Diagnostic by email within within 24 business hours, assuming the intake is complete.

If clarification is needed, you’ll receive a small number of follow-up questions before the diagnostic is run.

Private Pay System™ Visibility Diagnostic: Intake Questionnaire

Contact Information

Contact Name

Email Address

Practice Snapshot

Business Name