Practice Profitability Consult Application

This is an application for BIPOC-led primary care or mental health practices serving underserved communities of color who would like our feedback on potential opportunities to expand their profitability. If we determine that we can support your organization, we will also invite you to a call to learn more about how we can help you reach your goals.

Please be as detailed as possible so we can have a very clear understanding of your organization. *While we have supported many types of health organizations in the past, we are currently BEST equipped to support primary care or mental health practices that have been operational for >12 months, serve communities of color and have an annual revenue of $250k or more.

First Name *

Last Name *

What is the preferred email address that you check on a regular basis? *

What is your cell phone number? *

Do you consent to receive text messages from Melanin & Medicine? *

What is the name of your healthcare organization? *

City

State

Organization Website *

Please share the link to your organization's most active social media page *

Describe the social mission of your healthcare organization: tell us about the type of patients you are supporting and what problem in the community is your practice addressing? *

How long has your healthcare organization been operational and what is the size of the population (estimated) you now serve? *

Does your practice accept Medicaid insurance (if not, are there other ways low-income individuals will be able to access your practice)? *

On average, how much are your monthly expenses, i.e.your burn rate?(Use average of last 3 months)

What was your previous year's gross revenue in your business (Jan - Dec of the previous year)?*

What is your end of year goal for revenue? *

What is your current YTD revenue? *

What is your end of year goal for reach (patient volume)? *

What is your end of year goal for patient impact (health or social outcomes)? *

What are the most pressing challenges when it comes to reach your revenue goals? *

If your organization provides clinical services, how many full-time clinicians work in your organization (excluding you, if you are also a clinician)? *

How much revenue have you received from service contracts with other organizations in the last 6 months *

Our services focus on helping your organization not just secure 6-figure contracts but establish multiple partnerships that can lead to an ongoing pipeline of consistent revenue of 6-figures or more annually into your practice. from contracts. If we do decide to work together, what is your budget for investment to add this new multi 6-figure revenue stream from contracts? *

Why is now the right time for you to connect with Team Melanin & Medicine? *

\We take these inquiries very seriously and are committed to spending time and energy to identify what resources may be right for you. At times, this may even result in a referral to one of our preferred partner services for support.

Keep in mind that the more detailed your answers, the more likely we are to provide you with transformative feedback.