Is your group practice expanding to the point where you may need to hire a Chief Operations Officer? What does a Chief Operations Officer do? What are the benefits of hiring a COO?
In this podcast episode, Alison Pidgeon speaks with Valerie McNicholl on her role as the COO for Move Forward Counseling.
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Meet Valerie McNicholl
Valerie McNicholl is a Licensed Clinical Social Worker (LCSW) and the Chief Operations Officer (COO) for Move Forward Counseling. She has almost 20 years of experience as a therapist, supervisor and manager of programs in community mental health and substance abuse treatment programs. In her role as COO Valerie does a variety of tasks, including hiring, clinical supervision, expansion planning, and quality improvement.
In This Podcast
- What Valerie does as the COO
- Move Forward Counseling structure
- A deeper look into Valerie’s role
- What to look for in a COO
What Valerie Does as the COO
As the COO, I do a wide variety of things from supervising the administrative side of things to HR-related tasks. The way we are currently organised is that we have two therapists who have supervisory experience, so I directly supervise them as well. I’ve taken over the running and organising of staff meetings. Also, I have the opportunity and time to look at opportunities for growth. I work on marketing and co-ordinating with community organisations and other providers. I’ve also spend some time looking over the regulatory standards and documentation / details that Alison doesn’t have time to do.
“I really see, especially as we’ve grown, the importance of having that stuff solid. Because things happen and people interpret stuff in different ways, so if you don’t have a solid foundation in terms of the policies and procedures, things can definitely start to get unwieldy.” – Alison
Valerie does also see a small caseload of clients. From a business perspective, it’s nice for Valerie to also be bringing in a small income and not just solely be in a leadership position that can drain a company’s budget. From Valerie’s perspective, it’s nice to still have the therapist experience. However, this is most likely to change in the future as the company grows and Valerie’s COO role expands.
Move Forward Counseling Structure
The current structure of the practice consists of two teams of therapists with a manager of each team and Valerie then managing the two managers. This way, instead of Valerie managing all 20 odd therapists, she only needs to manage two people who then manage the rest. This also allows the managers to have more time to spend on clinical supervision and grow in this area. Valerie can also guide the managers in this area.
A Deeper Look into Valerie’s Role
Valerie manages the initial phase of hiring people, i.e.: creating the listing, screening the applicants, and doing the first interview. This then cuts down the amount of people Alison needs to interview in the second interview, and ensures that the people who reach the second interview phase are good applicants. Alison still enjoys being a part of this process as it’s such an important aspect. She enjoys discussing the company culture with applicants and also making sure they are a good fit in that regard.
In terms of general HR issues in the office, Valerie is the one who communicates directly with the HR company. But, Alison and Valerie communicate a lot about these sort of issues and how they want to resolve them. Valerie can then take care of a lot of the details that Alison doesn’t have time for.
At the start of her job, Valerie developed a basic auditing tool to use for various charts etc. Moving forward, this is something she will be handing over to the two managers to use within their teams. Valerie is also working to create videos so that the onboarding process for therapists is more consistent and automated. Finally, Valerie is working, together with a committee, on incorporating diversity and inclusion into the practice.
What to Look for in a COO
You need someone who has the ability to take something and run with it without having a lot of questions or needing to be micro-managed. It also helps that I (Valerie) have a lot of experience in a lot of areas of group practice. Alison and my values and goals are in line with one another. However, our personalities and communication styles are different. This helps to have two different perspectives on things, while still on the same wave length.
- Current Trends in Private Practice with Whitney Owens | GP 62
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- Consult With Alison
Meet Alison Pidgeon
Alison is a serial entrepreneur with four businesses, one of which is a 15 clinician group practice. She’s also a mom to three boys, wife, coffee drinker, and loves to travel. She started her practice in 2015 and, four years later, has two locations. With a specialization in women’s issues, the practices have made a positive impact on the community by offering different types of specialties not being offered anywhere else in the area.
Alison has been working with Practice of the Practice since 2016. She has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.
Thanks For Listening!
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[ALISON PIDGEON]: Is managing your practice stressing you out? Try Therapy Notes. It makes notes, billing, scheduling, and telehealth a whole lot easier. Check it out and you will quickly see why it’s the highest rated EHR on Trustpilot with over a thousand verified customer views and an average customer rating of 4.9 out of five stars. You’ll notice the difference from the first day you sign up for a trial. They offer live phone support seven days a week so when you have questions, you can quickly reach out to someone who can help. You are never wasting your time looking for answers. If you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your clients’ demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE] to get three free months of trying out Therapy Notes for free, no strings attached, including their very reliable telehealth platform. Make 2021 best year yet with Therapy Notes.
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[ALISON]: Hi and welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon your host. Today I have with me Valerie McNicholl, LCSW. She is actually the Chief Operations Officer for my practice, Move Forward Counseling. I’ve gotten a lot of requests from people over the past couple months to interview Valerie because they want to know what it’s like having a Chief Operations Officer in their own practice. If you’re starting to grow and looking at adding leadership positions this is definitely a really good interview for you to listen to. So I want to welcome Valerie. Thanks for joining me.
[VALERIE McNICHOLL]: Yes, thanks for having me.
[ALISON]: So I was hoping we could just start out, maybe talking a little bit about kind of your work history and the different things that you’ve done in relationship to leadership positions before you came to Move Forward. And you’ve been with us for about three months now, so it’s relatively new, but yes, I’ll let you go ahead and start with that.
[VALERIE]: Yes, sure. So I’m not originally from this area and prior to moving to Pennsylvania, I had kind of moved up through community mental health programs and did a lot with co-occurring disorders, drug and alcohol treatment. Pretty quickly in my professional career moved from being just a therapist or primarily doing direct practice to supervisory and management positions. So actually prior, immediately prior to moving here, I was doing more within the kind of quality improvement area and education. When I moved to Pennsylvania I went back to being a therapist and again pretty quickly moved into more kind of management positions. So just prior to coming to Move Forward, I was with a community mental health organization running a couple of different types of programs within that organization, supervising staff, building new programs, kind of taking over programs that were struggling and making changes to make them more successful. Yes, so that’s kind of what I was doing before here. And the management and supervision piece of the work has always been what I’m most interested in. So this has been a great fit for me.
[ALISON]: Nice. So you came with obviously a lot of experience with managing staff and like you said, overseeing programs and that kind of thing, which is why you were a really good fit for us. I’m curious if you, especially now that you’ve been here for about three months, if you could kind of describe what exactly you’re doing on a regular basis or like what types of things you’re in charge of as the COO.
[VALERIE]: Yes, so I do a wide variety of different things, everything from kind of supervising the administrative stuff, doing some HR stuff in terms of hiring new staff dealing with any difficulties that there could be with staff or concerns with staff, whether it be the therapist or administrators. The way that we are kind of organized right now is that there’s kind of two therapists that have a little bit more of supervisory experience and so I directly supervise those two therapists as well. I’ve taken over running some of the staff meetings and kind of organizing those staff meetings too. I think you know, I’ve been kind of keeping track of stuff. As the month goes along, we meet monthly, as the month goes along, keeping track of what needs to be discussed in staff meetings and then sort of delivering that information.
I have the opportunity, I have the time that you don’t have some times to be able to kind of look at opportunities for growth. I work on marketing and coordinating with community organizations, other providers, that type of thing. We’re in the process of looking at growing in different ways and so building new relationships. I also kind of had the opportunity to look a little bit more deeply maybe into some of the regulatory standards and those types of things, and just kind of do a little bit of oversight of documentation and those types of some of the details that I think is difficult for you to manage with all of the things that you have to do. So it’s a lot of different things. It’s really interesting and fits really well with the things that I enjoy doing.
[ALISON]: Yes, that’s funny that you say that, because I know we talk about that a lot, how like those details can kind of drive me crazy and I’m happy to give those to you. And when you came, you were really excited, which these tasks is like, sounds terrible to me, but you were excited to kind of tighten up and like rewrite some of the policies and our policy and procedure manual and that kind of thing, which is really — [crosstalk]
[VALERIE]: But I actually do like doing that. And that comes from the QA background. I understand the importance of policy and procedure and what can happen if you don’t have well-written clear policies. So yes, I mean, that was something I, it is something I enjoy.
[ALISON]: Yes, and I really see, especially as we’ve grown the importance of really having that stuff very solid because just things happen or people interpret things in different ways. And so if you don’t really have a solid foundation in terms of the policy and procedures, things can definitely start to get unwieldy, so to speak. So I know you also, we didn’t mention this, but you also carry a small caseload of clients and I think that that’s probably something that’s going to shift and change as we grow bigger as an organization. You probably will get to the point where you don’t see as many clients right now, but, or maybe no clients at all, but I just thought I would mention that piece, because that does you know, from a business perspective, obviously when you’re, somebody in a leadership position is generating some income, it makes it easier to bring them on because they’re not just like a total drain on the budget, so to speak. So I think you, how many clients do you see a week, about 15 or is it less than that?
[VALERIE]: Yes. About 15 and I think for me you know not coming from within the organization, it’s been helpful for me to do that because it does help me to understand the systems that we’re using and those types of things and to be able to understand what the therapists, like from the therapist perspective. So that’s been helpful for me to do that, even though I do anticipate at some point in time that probably will not be part of my job.
[ALISON]: Right, right. Yes. So I thought maybe we could talk a little bit about the structure. So right now we’re located in just one county, in Lancaster County and we have about 23 therapists, is that right? I think we just counted this morning, and so we’re looking at, the structure would be a team of two therapists. So two teams of therapists and then kind of a manager over top of each of those teams and then you would be the manager of the managers. And so as we grow bigger, obviously you’re not going to supervise each individual therapist, but you would just be like the touch point or the support for the manager of that individual team. So that was really the thought that I had with bringing you on, is that again, you’re going to grow to a size where you’re not going to be able to do it all. And so still having that manager and having the team be small and, 12 people felt like a sweet spot but still have somebody who’s sort of like overseeing more of the high level stuff. So instead of you managing 24 people, maybe you’re only managing two people and we’re kind of growing into that, but I don’t know if there’s anything else you want to say in regards to that.
[VALERIE]: No. I mean, I think, yes, I mean, we’re in the process of kind of moving a little bit more in that direction, but I feel like it’s a good plan. I think it kind of keeps some of the things that are nice about having a smaller team you know, and people, especially in a virtual world having more of like relationships among those teams with the therapist. And so I think it’s going to be, I think it’s going to look really good for both for us as an organization for individually the therapists to have somebody have a direct supervisor that is only supervising up to about 12 people. So have some more availability to really do some clinical supervision and an opportunity for the supervisors to grow in their supervision. I think probably you know, we’re still figuring out some of the details, but likely those two people will pretty be pretty new supervisors and so the fact that I will only be sort of directly supervising those two really gives me the opportunity to really provide a lot of direction and support to new supervisors, which is exciting for me as well.
[ALISON]: Yes, I think that’s a really good point. It’s hard to find somebody who already has kind of management or supervisory experience, but we definitely have staff who are interested in doing that. They just haven’t had the experience before and so I think that is going to be kind of a big piece for you of like mentoring them and like teaching them how to be managers essentially.
[ALISON]: So maybe we can dig into kind of a little bit more, because I know you kind of gave us the overview of what all that you do in terms of all the different tasks that you have, but maybe we could dig in with a little bit more detail. So maybe we could start with the HR piece. So maybe we could talk a little bit about like what you do versus what I do because I’m kind of still involved, but maybe just not as much as it was in the past.
[VALERIE]: Yes, definitely. So kind of starting off at the beginning and the hiring piece of things, the role that I’ve taken on is almost kind of screening applicants for positions. So since I have started, we have hired therapists and administrative staff. So we’ve gone through the hiring process of each position and kind of what I’ve done is managed the actual listing of the position, screening the applicants and kind of doing, like I said, an initial interview. So that way, if I can kind of screen out and save some time for you in terms of how many people that you’re actually meeting with. So that’s worked out really well, I think and certainly saved some of your time in terms of monitoring that and hopefully as it’s worked out, by the time we kind of get to that second interview that then you’re involved you know it’s generally a fairly good candidate or seems like a fairly good pick at that particular point in time.
So I think when there have been, as far as like HR issues go, like you know, if there have been issues related to staff, like I’ve been kind of the one that’s communicated directly with our HR company. But you and I have really communicated a lot and kind of made decisions together in terms of what direction to go and how to support staff, talking to staff about if there were concerns or that type of thing. So it’s really been, I think like a team effort in terms of dealing with the HR stuff which I think has worked out good. And I can kind of take care of again, of some of the details that take up more time when you don’t have the time to be able to do that.
[ALISON]: Yes, so I used to do that whole HR process really from beginning to end, or I guess the administrative assistant would post the job posting, but I was doing all of those pieces and now I’m kind of just coming in at the end and doing a second round interview, which cuts down on the amount of my time of potentially dealing with somebody who’s not a good candidate. So that’s been great and I, obviously by choice still want to be involved in the hiring process because I feel like that’s such an important piece of having a successful practice. Obviously you’re hiring people to perform a service and having good people can really contribute in a humongous way to the success of the organization. So I think I certainly wouldn’t have to be involved, I guess if I didn’t want to be, like, I could see how a COO might just take that over altogether, or maybe if you hire like an HR director or something like that, they would just do all of that. And maybe one day we’ll get to that point, but I like still being involved. So that’s just how we have it set up right now.
[VALERIE]: And I think the staff appreciate that as well, that you have a face and you’re involved. I mean, I understand at some point that might not be a possibility or it may not be the direction we go in, but I like, and I think the staff appreciate having a relationship with you that kind of starts with the hiring process.
[ALISON]: Yes. And I like talking to them about the kind of values of the practice and the culture and making sure that they understand what it’s like to work here so that they can determine if it’s a good fit for them. Because again, that’s such another such important piece to having a successful business is that they really understand what it’s like to work here before they make that decision.
[ALISON]: Yes. So what else, I know you mentioned a bunch of things, so like the kind of the quality improvement pieces, obviously there was things already established in place. I don’t know if there’s much to say about you kind of just came in and reviewed everything and made improvements where you saw fit kind of thing, which was super helpful. Anything else related to that? That’s pretty cool, right?
[VALERIE]: No, I think it was, yes, and I think that, again, the detailed stuff that’s hard to do when you have a million other things to do, part of what I did when I first started was in addition to kind of like reviewing regulations and stuff I developed an auditing tool and that’s one of, so that we can audit charts and do those types of things. Really simple, nothing too complicated, but just enough to make sure that we are kind of seeing what’s going on in the documentation. And that now, as we changed the structure a little bit and have some clinical supervisors overseeing the teams, that’ll be a task that we’ll then be transferring to to those clinical supervisors. So that’ll be one of those tasks as they get up and going with their teams as kind of having their eyes in some of the charts and auditing and we have a tool that we can use for that.
[ALISON]: Which we had not had before.
[ALISON]: So, yes, I appreciate that we have that now, again, because as you grow bigger, you want to make sure things aren’t falling through the cracks. So I think some of the other things, and feel free to jump in here too, if I’m missing something, but some of the other things were just like more project type things that maybe had just gotten started, or I had an idea for, and I didn’t have time to start. To like realizing that we developed a training to put all the new therapists through, but like nothing was recorded. Like I think some things were written down, but it wasn’t automated really in any way and so you’re working with the trainer on like actually making videos and like loading that into a platform where people can watch the videos. Not that we’re not going to do any like in-person training, but again, just from like a volume standpoint, it just would save so much time to have all of that stuff prerecorded.
[VALERIE]: Yes, it saves time and it ensures that everybody’s getting the same training, you know that there are things that are not being missed or communicated differently. So yes, we’re going to be using an LMS, a learning management system program to have our orientation information, generally real basic stuff, like how to use our EHR, how to deal with the billing kinds of situations, the other resources that we have for therapists, just kind of going through all that basic stuff. And so then it will be consistent for every single like new therapist that starts which is great so we know everybody’s getting exactly the same thing.
[ALISON]: Yes, and we had already had a therapist who’s additional responsibilities in addition to seeing clients obviously was to train all the new therapists. So you’re working with her on what she already had and we’re just kind of taking it to the next level. So I feel like that’s a fair amount of the stuff that you know, like I said, we already kind of had something there, but it just needed to be like improved upon or made more efficient or something like that. Anything else that sticks out to you that you’ve been working on that’s more of like a project type?
[VALERIE]: Yes. One of the ideas that you had had, and I’m not sure how developed that was prior to me coming on, but was having a committee to address inclusion and diversity. So that’s something that I’ve started since I started with Move Forward and that’s an exciting thing for me. That’s definitely something that I feel very passionate about, so to speak and really enjoy working with the staff, the therapists and administrative staff on how do we show the community that that’s an important thing for us and how do we make sure that we’re presenting ourselves as a business that values diversity and inclusion. So that’s been something a little bit separate than the clinical work and those types of things, but absolutely an important and very valuable piece of work.
[ALISON]: Yes, I’m glad you brought that up because yes, that is something that obviously really came to the forefront last summer. And then we were trying to figure out how do we really start to look at this and not just give lip service to it, like, “Oh, sure we could write like a statement, put it on our website about how are you actually going to live it out.” And so that’s really the purpose of the committee. And so again, just something that I didn’t have a ton of time to devote to kind of organizing that and figuring out what to do around that. So you took that on when you started in January, which is great and we had staff kind of volunteer if they wanted to be a part of it. But it was really important to me that, like we heard from, you know it wasn’t just like you and me making decisions about how to make changes.
It was like getting input from the staff and having those conversations because obviously it’s like if they’re not involved and they’re not going to be invested and they’re not going to carry it out in our day to day of how we do our work. So, yes. So I think that that’s been a really important thing that you’ve taken on and it’s led to some good conversations among the staff. And we’ve already made some changes, which I think are good, like making more, identifying our pronouns on the website and our Zoom accounts and those types of things. So, yes, it’s a work in progress.
[VALERIE]: Yes. And I think both with the diversity and inclusion committee, as well as like some other areas, part of what we’re doing, and again, I have more time to be able to kind of research these things, but looking at what kind of training might be beneficial to our staff. And so certainly in terms of the diversity inclusion, it’s kind of identifying what speakers or educators might be good for us to have come into the practice and really work with our therapists around that particular issue. So I’m able to connect with people in the community and find those resources. So we’ve done similar things in relationship to like identifying other maybe areas of need, you know with the pandemic going on and kind of just every, the state of the world.
We’re recognizing trauma more and more is a relevant issue and something that’s really a significant need in the community. And so we’ve had a lot of conversations and done some outreach in terms of how do we educate our staff, how do we provide or help them get more education, more information, certification, any of those kinds of things so that we can treat the need in the community. So I’ve been able to again, have the time to be able to kind of connect with resources and start to work on getting some education available to our staff in a way that meets the need of the community.
[ALISON]: Yes, it’s also interesting. We’ve been seeing a lot more requests for clients that have eating disorders or eating disorder type behaviors. So we’re also looking at that because that is a big, there’s hardly anybody, I think, in this area that treats those clients, and so looking at getting our staff trained and how we can do that in a way that’s going to meet the need of the community. So yes, I think that’s all great to be able to respond to that, especially in a timely manner and I think that’s one of the great things about being a small business is that we can make those decisions fairly quickly to get staff trained or that kind of thing as opposed to like a larger organization that has more bureaucracy.
[VALERIE]: Sure. Yes. I mean, we can adjust pretty quickly to the, what we’re seeing in the community and what individual’s needs are.
[ALISON]: Right. Yes. And so the other big project that you’re working on is we’re looking at expanding into the county next to us. And so like we were talking about before with the structure, there’ll be a whole another team, or potentially two, three, I don’t know how many teams, that we’ll have to set up kind of a whole new office. And we decided it’s going to be a whole separate, it’s far enough away that it makes sense to have it be a whole separate thing. So a whole separate website, separate staff, like staff isn’t going to travel back and forth between the two. So that obviously is going to be a big project. And that was one of the reasons why you did so much work, like just kind of tightening things up in the existing office. It was because we wanted to like take that model and just be able to replicate it in the other location. So I think that’ll be really exciting to see how that works exactly because you know, so much of business is really just figuring out like a really solid model. And then once you do, you can just keep replicating it as many times as you need to.
[VALERIE]: Yes. And I mean, so we, obviously we have that model from all the work that you have done in developing and starting Move Forward but it’s in a brand new environment. So it’s all about like building those relationships and getting our name out there in that new county because we have a pretty good reputation and are pretty well known in our home county. But I mean you know how much work it is just to connect people, connect with people in the community. So it’s a lot of that and it’s important, it’s exciting but it’s also really time consuming. So I can’t imagine how you would have the time to be able to do those kinds of things, but it’s definitely exciting to be looking at growing and starting something new.
[ALISON]: Yes. It’s kind of weird. It’s like starting from scratch, but not really at the same time because you already have this model that works and has been successful somewhere else. And so like, I think probably most people in that county, like have never heard of us because it’s far enough away that like, they wouldn’t be looking in Lancaster for services, but yes, so it’s like in some ways you’re starting from scratch, but in a lot of other ways, you’re not. So yes, it’d be interesting to see how all that kind of fleshes out.
[VALERIE]: Yes, yes. No, it’s exciting.
[ALISON]: Yes. So I thought maybe in the few minutes that we have left, I don’t know if you have any thoughts about you know, if other practice owners were looking at bringing on somebody in a leadership position maybe to, like I did where you kind of took over a lot of the things that I had been doing. Do you have any particular advice for them about how to decide what to delegate or how to make that whole transition go smoothly or anything like that?
[VALERIE]: Yes, I guess, my immediate thought is really, I think, and I hope you think this of me, but that you really need somebody who can be pretty independent you know, that can take a direction or an idea and kind of run with it. I think it would be really, it wouldn’t work so well if I had tons of questions or needed micromanaging in relationship to any of these projects, because it just, it wouldn’t work. It wouldn’t help. So I think that that’s an important piece of it. I think the fact that I do have experience in a lot of the aspects of managing programs, working within budgets, supervising staff, those are all things that I’m very comfortable with and so there’s no like learning curve other than, you know obviously it’s a little bit different because it’s a different company and a private practice and those types of things, but I’m very comfortable with those tasks and familiar with them.
So I think that experience, had I not had that experience, I think it would have been much more difficult for me because there definitely have been things that have been brand new to me which is also exciting and nice. But there’s a lot, that’s not completely brand new, you know that are things that I have done in previous jobs and those types of things. I think also, and this is something you and I have talked about is that, and I think it’s definitely a benefit of value in that you and I are different in a lot of ways. Like our goals are the same. I think our values are the same in relationship to the business and the treatment, the importance of treatment and the importance of the staff, the value that we put in our staff. But our personalities are different, our communication styles are different and I think that really helps because if you have two different sets of eyes on an issue or problem or potential opportunity, there’s more opportunity to see things from a different perspective. And so I just think that that’s actually been like a really good match.
[ALISON]: Yes, I agree. And that’s actually one of the reasons that I hired you is because I knew you were different from me. And I thought that would be good actually for the staff.
[VALERIE]: No, I think it’s been great.
[ALISON]: Yes. I think I agree with everything that you said about having that past experience like managing staff is pretty similar, whether you’re in a big agency or you’re in a smaller company. So having those experiences definitely helps because you know, things come up and you have to have difficult conversations with people or whatever. And it’s like after you’ve done it a couple times, it’s like not as scary as it was the first time you had to do it and so just not having that fear or like just that you know, doing it for the first time. Like you’re past all of that. So yes, there hasn’t been a lot that I’ve had to do with mentoring you in that way, which is great. And then also, yes, I do appreciate the fact that you can be very independent and take my ideas. And sometimes I don’t always explain them super well, but you try to figure out what I need. But we meet once a week to kind of discuss how these different things are going and we have a Trello board that we use to keep just the different pieces organized because you know, there is a lot going on and it’s easy to kind of forget about one of the 27 things you’re working on at one time. So we just try to check in with each other and make sure I’m answering your questions that you need to have answered to keep moving forward with things.
Yes, I think it’s working out really well. Yes, so I wanted to say thank you so much for coming on the podcast today and being so open to being interviewed.
[VALERIE]: Appreciate it. I’m glad I could. I’m glad I could speak.
[ALISON]: Yes. Thank you so much.
[VALERIE]: All right. Thank you
[ALISON]: Once again, thank you so much to Therapy Notes for sponsoring this show. It makes notes, billing, scheduling, and telehealth a whole lot easier. And if you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your client’s demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE] to get three months free to try out Therapy Notes.
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