Clinic Inquiry & Pilot Intake

Tell us how your front desk runs today. Everything here is used only to scope your pilot or monthly retainer — nothing is shared outside the OpenLingua operations team.

Practice Profile

Practice name *

Specialty

Clinic director / practice manager *

Direct phone

Work email *

Practice location (City, State)

Practice website

Clinical Scope & Schedule Setup

Clinical procedures offered

Practice management / EHR platform

Monthly non-English inquiry volume

Primary language needed

Additional languages (optional)

Engagement Selection

Start with the 20-Lead Initial Pilot ($450)Schedule a 15-Minute Operational Discovery CallRequest Practice BAA and Custom Monthly Proposal

Anything else we should know? (optional)

Submitting this form does not create a contract. A Business Associate Agreement is executed before any patient information is handled.