Practice Design & Layout Consultation

1. Practice Information

Practice / Business Name

Primary Contact Name & Title

Email Address

Phone Number

Practice Website (if applicable)

City / State

2. Practice Type & Services

Which best describes your practice? (select all that apply)

Independent Pharmacy

Medical Practice (Primary Care / Specialty)

Med-Spa / Aesthetics

Functional / Integrative Medicine

Wellness Clinic

Other (please specify in services)

Primary services offered (or planned)

3. Project Scope

What best describes your project?

New build

Renovation of existing space

Expansion of current location

Workflow / layout optimization only

Retail merchandising & patient experience focus

Estimated square footage of the space

Is this space currently:

In use

Under construction

In planning / lease negotiation

Not yet secured

4. Goals & Challenges

What are your primary goals for this project? (select all that apply)

Improve patient flow

Improve staff workflow & efficiency

Increase retail or service revenue

Create a more elevated patient experience

Add new services (aesthetics, IVs, hormones, etc.)

ADA / compliance considerations

Other (please specify in challenges)

What challenges are you currently experiencing with your space?

5. Timeline & Budget

Ideal project timeline:

ASAP (within 3 months)

3–6 months

6–12 months

Exploring / future planning

Have you established a budget range for this project?

Yes

No

In progress

If yes, approximate budget range (optional):

Under $25k

$25k–$50k

$50k–$100k

$100k+

6. Design & Branding

Do you currently have brand guidelines (logo, colors, fonts)?

Yes

No

In progress

How would you describe the look you're aiming for? (select all that apply)

Clean & clinical

Luxury / high-end

Modern & minimal

Warm & wellness-focused

Retail-forward

Unsure / need guidance

7. Consultation Details

What type of consultation are you interested in? (select all that apply)

Space planning & layout

Patient & staff flow optimization

Retail merchandising strategy

Service room design (exam, IV, aesthetic rooms)

Full design strategy & roadmap

Have you worked with a designer or architect already?

Yes

No

Not yet

8. Additional Information

Anything else you'd like us to know about your project?

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