
The Private Practice Success Podcast
Private Practice Specific Business Coaching, Mentoring & Consulting for Allied Health Business Owners.
The Private Practice Success Podcast
38. How to Spot & Plug Leaks in your Practice's Cash Flow
In episode 38, Gerda tackles one of the most pressing challenges facing private practice owners in 2025: Cash Flow.
With rising expenses, changes in client spending habits, and economic contraction, it’s never been more important to keep a close eye on where your money is going and where it might be slipping through the cracks.
Drawing on real-world examples and her extensive experience supporting allied health businesses, Gerda walks you through the three most common 'cash flow leaks' she sees in group practices, and shares practical strategies to help you spot and plug them before they become major issues.
This episode is all about empowering you to take back control of your finances, reduce stress, and make sure your hard work translates into a healthy bottom line.
In this Episode, you will learn (among others):
- Why cash flow is such a critical issue for practice owners right now and why you’re not alone if you’re feeling the pinch.
- How to identify and manage the three 'usual suspects' when it comes to cash flow leaks.
- The importance of regular reviews and clear processes to keep your practice financially healthy.
FREE Download:
Get Gerda's Excel Fee Calculator (with video walk-through on how to use it) that will take you through how to set the fees within your private practice. No more guessing - just clear data on what this number needs to be in order to build a long-term sustainable business.
Who This Episode Is For:
- Allied health practice owners wanting to strengthen their financial foundations.
- Business owners who suspect money might be leaking from their practice but aren’t sure where to start.
- Anyone ready to take practical steps to improve cash flow and build a more sustainable, profitable business.
Tune in now to learn how to spot and plug the leaks in your practice’s cash flow and take one big step closer to building a practice you can’t stop smiling about 😊
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Well, hello there amazing private practice owner. My name is Gerda Muller, and you are listening to the Private Practice Success Podcast, and this is episode number 38.
The title of today's episode is How to Spot and Plug Leaks in Your Practice's Cash Flow.
Let's be honest right now. Currently cash flow is a significant issue for the majority of practice owners. In fact, it is a significant issue for the majority of business owners, irrespective of what industry or sector you are operating in. It just is what it is.
As an Australian community and market, we are finding ourselves in a time of economic contraction. Yes, interest rates have just started to go down. But the impact of many, many months of increased interest rates has filtered through and has had significant impacts on our clients, as well as on us. We are also humans. We also have mortgages. We also have bills. So everyone is feeling this period of economic contraction where people are thinking twice about each and every dollar that they are spending.
Yes, people are still spending and people will spend on things that they value, but there is more considered spending - and we are all feeling it. Coupled with the significant increases in business expenses - expenses such as the increase that is kicking in on the 1st of July with regards to super that employers now need to pay - the increase in award base rates and just general increase in business expenses.
All of these things have accumulated in this perfect storm resulting in significant cash flow difficulties. So if you are struggling with your cash flow, please know that you are not alone. It doesn't mean you don't need to address it or attend to it, you still need to do that. But know that this is not a personal failure. It is about the environment that we are finding ourselves in.
As savvy business owners, we need to look at that, step back and then go, Okay, what can I do within my business, and within my industry, to spot and plug any cashflow leaks.
High Level Cash Flow Management
What I want to do today is provide high level context around cash flow and what you can do about it. Then we're going to go from high level to eye level, where I want to speak to you about specific things that you need to address, to spot and plug those leaks.
Generally, when a business owner has cashflow difficulties, they do one of two things. So remember, there's three things you can do, but people generally do one of two things.
Revenue Generation
First thing is revenue generation. So they go, “Alright, I'm struggling to pay my bills. There's more money going out than going in. You know, I'm waking up in the middle of the night worried and concerned about how I'm going to make wages, all of that type of stuff.”
And then they go, “Alright, we need more clients. Maybe there's open slots in the diary. Maybe the phone has stopped ringing. Because remember I said earlier, people are more considerate now in where they spend their money. Maybe the market that you are operating in - clients are finding it really hard to pay out of pocket for these sessions, for example.”
So you might go, “Alright, I need to engage in revenue generating activities.” Generally, people then go, “Okay, I need to do marketing. I need to do business development.” And then people go crazy on the revenue generation side of things. Nothing wrong with that, okay? So what they're doing - they are turning, or hoping to turn on the revenue tap for more money, cash revenue coming into their bucket. So that's the one thing that you can do. I am not going to talk about that today - that's a totally different topic. But remember, we are going high level first.
Expense Auditing
The second thing that people generally do is they go, “Let's cut expenses.” So it's like they dive in and they do a really in depth expense audit. Now, that is a big topic of discussion - there's a lot that goes into that and doing that well. And again, we're not going to talk about that today, but generally that is the second thing that people will do.
What I will say about cutting expenses is the number one mistake people make when they do that, is they go in and they say, “Okay, I've got all these bills. I need to cut expenses,” and then they cut not only the fat, but they cut into the muscle - so they go totally overboard. People generally do that because the revenue generation strategies weren't paying off, because revenue generation just doesn't happen overnight. It takes time.
If they haven't been consistent with their branding and their marketing and doing all the right things when it comes to business development, they're going to be really busy trying to do all the marketing stuff, but getting very little return - because it takes time. And then they go, “Oh, shit, this is not working, now I need to cut,” because they're now feeling more panicked, more stressed, more worried - they start to cut into what I refer to as the muscle of the business. And you know what happens when you cut into the muscle? It stops working. You can't walk if your muscles aren't working, your leg will give way underneath you. So, it's really important to avoid that mistake.
I know it's hard because you're going, “I'm just going to strip everything as bare as possible.” But if you cut expenses that are required to operate your business well, you're going to just be shooting yourself in the foot. So it's not only about looking at “What is a service that I no longer need?” It's also about going, “ Does this service actually give me a return on investment”? Because if you spend $50 on something as an expense, but you are making $150 back on it, then that's an expense you should keep.
But people don't go through that cognitive exercise, like I said, there's a way of doing an expense audit and doing it right versus just going, “I can do without that for the next three months.” Then in three months’ time, you are in a worse off position. So please do not make that mistake. Which is why, when you have cashflow difficulties, you need to do all three things.
You need to do the business revenue generation activities that I spoke about earlier. Yes, you need to do the expense audit - but appropriately. Then you need to do this middle piece, and we are going to be talking about the middle piece today.
When you think about it, it's a key chain of three activities that you need to engage in. And it's only by doing all three to the appropriate level - to an appropriate extent, not going totally crazy, just doing what is required - but doing all three, that will help you address cash flow difficulties.
Again, this is where people often go wrong in business. They go, “But I'm doing all these revenue generation strategies. Why isn't it working?” Well, it's because there's only one part of the puzzle. You need all of the puzzle pieces to get to the result at the end of the day.
So today I am going to talk about what I see to be the middle piece. So I look at revenue generation as the first piece. I look at plugging the cashflow holes as the second piece. And then the third part really to me is the expense audit. I would generally do it in that sequence. I'm always focused on revenue generation, marketing, branding, that stuff is always happening.
Second, I would do the plugging of the cash flow leaks. And then third, I would do the expense audit - because I know if I do the expense audit fast, there might be panic in the way that it's done, there might be desperation in the way that it's done. And I also know when you cut into the muscle, you are self-sabotaging your business - and we don't want that.
Cash Flow Leaks
So let's get stuck into how to spot and unplug those cashflow leaks within your private practice. Now, I know you probably know this already, but just for clarity - what is a cashflow leak? This is when money is leaving your business unnecessarily, or it's money that goes uncollected. A lot of times it's not obvious. And a lot of times it might not be big - but it adds up over time.
If you don't address it, it means that you will be working harder and harder, possibly on revenue generation. You'll be cutting more and more as part of your expense audit, but not really seeing the returns on those activities because there's holes in your freaking cash bucket. It's like a fruitless exercise, having the tap of revenue open as wide as possible. It's like you cannot turn this tap open wider - you've done what you can, but there's holes in the bucket. Does that make sense? So you have to plug the holes.
It’s a common misperception, I think, amongst practice owners where they go, “But if there was a leak, I would know about it. Surely, I would notice. I look at my Xero account every day. I look at my bank account every day. I look at my Xander, my Clinical, my whatever program I use - every day. I would notice.”
Well, I am sorry to say - you are probably not noticing it - because unless you are actively looking for it, you won't see it. There are just too many other things vying for your attention as a business owner. So you need to consciously and actively be looking for these holes in your bucket so that you can spot them - and then plug them.
For the purpose of today's episode, I'm going to talk to you about what I like to refer to as the three usual suspects when it comes to cashflow leaks. Obviously, there are many, many potential cashflow leaks, but I want to highlight these three to you because I obviously work with a lot of group practice owners. I help a lot of group practice owners to identify and plug their cashflow leaks, and these are the three that pop up the majority of the time.
I'm going to share all three with you, and this is in no particular order. As we go through these three usual suspects, I'm going to ask you to just make a mental note for yourself and ask yourself: When did I actually look at these three? If you've not looked at it in the last quarter - big red flag - you need to go and do that ASAP.
Ideally, as a minimum, you want to look at this on a monthly basis. I would recommend it if you've not been looking at it, that you should get stuck into it on a weekly basis, until you have a system and a process around addressing these consistently.
So let's get stuck into the first usual suspect.
Not Charging for No-Shows & Late Cancellations
Not charging for no shows and late cancellations - even though you have a no-show and late cancellation fee. This happens so often. I'm pretty sure that by now the majority of group practice owners - like 99.9% of you - will have some type of no-show and late cancellation fee policy written into your consent form, or into your service agreement if you're doing NDIS work.
But the amount of practice owners that waive those on an ongoing basis are exorbitant. My opinion is - why have this policy if you are not going to enforce it? You need to think of the implications of not enforcing these. Imagine your average session fee is $250 per session. Now imagine you have two clients that either No-show or cancels really, really late - too late for you to refill that appointment. So you lose two appointments a week.
Let's say your practice only operates for 42 weeks out of a 52 calendar year - because there’s holidays, people are away - all of those things. I always like to be really conservative when I look at these financial numbers. So $250 times two - that's $500 that you will lose for that week, times 42 weeks in a year - that is a roundabout $21,000 loss a year.
Now, when you think about it, if you've got a large group practice and you've got 10, 12, 15, 20 clinicians, you're going to have way more than two no shows and late cancellations a week. Before you know it, it all adds up. So this is a hole in your bucket - and you are the one creating the hole - because you've got your policy, but you aren't applying the policy. It's like having a boundary in your relationship, but you don't hold the boundary, right?
So I want you to ask yourself: Do you have a clear no-show and late cancellation fee policy? I'm pretty sure you do - but maybe it's time to revisit it. If you are interested, I'm happy to share with you what that is at my group private practice. We charge a no show and a late cancellation fee. We charge 100% of the session fee if you no-show, or if you cancel with less than 48-hour notice. That is our policy.
Now, obviously if somebody no-shows, we've got zero chance of refilling that appointment. If somebody cancels, let's say, within that 48-hour window, we will always do our utmost to refill that appointment slot - our reception is really well trained in how to do that, but sometimes it's just impossible. Even if you do all the steps, do all the things, you might still not refill it. Obviously the shorter the notice, the less likely the chance of refilling it. So if we do refill it, we don't charge the client - because that would be in my books, double dipping. But if we can't refill it, we will charge that fee.
Now, I will also say that I'm not totally ruthless here, I've got three kids myself, and I've got a child and adolescent practice. Sometimes kids just get sick during the night - like there was nothing wrong with them yesterday, and all of a sudden, they start vomiting all over the place in the middle of the night - and you can't take them in for the appointment the next day.
Obviously, these days with telehealth, that's always an option. Could we do telehealth? Could we change that session into a parent session via telehealth, for example. Sometimes clients get involved in car accidents or they are in hospital - there's always extenuating circumstances. So I'm not saying be totally black and white here - because I'm not. And I'm not going to tell you to be totally black and white. There's always extenuating circumstances and we will check and ask what that is, and we will not enforce the fee if there is an extenuating circumstance. But do you have a policy around what that is? That's the other question.
Because yes, you might have a policy around what are the fees that we're going to charge - but what happens when reception finally gets hold of the client and they had a crisis that was unforeseen, that was not their fault - a crisis that really they shouldn't be penalized for? How do you make that decision? How does your team at the front desk make that decision? Or do you need to go through a process every time of deciding. And then ultimately you just go, “Oh, just wave it for today”?
Because maybe you're just too tired to think it through. You're exhausted. Maybe you didn't sleep well. Maybe you've had a super busy day, or you are running to your next meeting - and then you are making emotional decisions. When in fact what you need is a policy, a flow chart, a decision tree that says, “Okay, this has happened. Alright, what's the next step? If this has happened, what's the next step?”
At our practice we have a decision tree. It's a flow chart that we drew up in Canva. Our front desk team has it and they just follow it. It really makes making the decision easy and this means that it doesn't even have to be escalated. Yes, there's ultimately an option where it does get escalated, but nine out of 10 times it doesn't even have to go to the practice manager - because we've got a flow chart to help people make that decision. So it's really important to empower your front desk team with knowing how to enforce the policy. So one - you need a policy and you need to train your team in how to enforce it.
Now one of the biggest objections practice owners give me when it comes to charging these fees are that, “Well, clients aren't going to pay it Gerda,” or “I'm worried that they're going to ghost me, or they're just not going to come back because they're going to be upset at me for charging it.” I always say that clients should never be upset at you for charging a cancellation fee - because they should know what the policy is. They need to be reminded all of the time.
When we apply a no-show cancellation fee policy, I want to feel good about it. I don't want a client coming to me and saying, “Well, I didn't know that this exists.” So you need to also be really confident and clear about how you've communicated the existence of this policy to the client.
Underbilling
The second usual suspect is what I refer to as underbilling. Now, I can go in a lot of different directions with under-billing because I'm very aware that people listening to this podcast will have had different levels of exposure to business coaching, mentoring, and consulting by now. So if you are listening to this and you're going, I would never do that Gerda, that's amazing. But you need to remember that not everybody has had the same level of exposure.
So a very salient example of under billing would be if the majority of your revenue at your business is based on bulk billing clients. Because let's be clear - the amount of money that you can bill Medicare when you're bulk billing a client isn’t enough to run a business in 2025. Please don't get offended when I say this, but you are running a charity or you're running a hobby if that's what you're doing - and I don't think there's anything wrong with that.
There's nothing wrong with going, You know what? I don't need the money. Maybe you've got a husband or wife or a partner that has a really amazing well-paying job and you can give back in this way by having a bulk billing practice. That's awesome. If this is what you want to do, start an NGO. Don't do a PTY. Limited business and bulk bill. It defeats the object - and I don't want you to burn out. So rather get the tax benefits from providing a bulk billing service and own the fact that this is what you are doing. Nothing wrong with that. There's a space in the industry for all types of businesses.
There's a space for the hobby allied health professional that maybe only want to see four clients a week - perfectly fine. There's a space for NGOs and people running charities. Then there's a space for private business - and I own a group, private practice, and that is the audience that I'm talking to. Generally that's who’s listening to me, and that's the people that I work with. So when I refer to under billing - if you are still bulk billing - I'm talking to you if you've got a PTY limited company.
If you are paying tax on every dollar that you earn, when you are a director of a company and you have a fiscal and a legal responsibility to be running a solvent business - meaning you could pay all your bills and meaning your business is running at a profit - okay? You've got a responsibility as a director of a company to ensure that happens. And right now, I'm telling you, if you are bulk billing all your clients as a PTY limited, I don't see how you can do that. So that's an example of under billing.
Another example of under billing might be when you know that the session fee that you are charging is not enough to cover your operating expenses and make even a whiff of profit. So how do you know what you should be charging then? I should probably do a separate podcast episode just on how to set your fees and how to increase your fees. In actual fact, I do have an Excel sheet that I use at my practice and with my own business coaching and mentoring clients to help them determine what your session fee be in order to pay all your bills and make a profit.
If you want a copy of that, what I might do is pop a link to that Excel sheet into the show notes. So please check out the show notes - it'll be in there - and you are welcome to download it for free. This is my gift to you so that you can actually have a look at: Am I under billing my clients at my practice right now based on my expenses?
I can tell you - doing that Excel sheet is not fun. I have only once had somebody reach out to me telling me Gerda, I'm actually on par and I'm charging exactly what I should. Everybody else always comes back to me and says, That was so sobering, Gerda. That was so eye-opening. This now makes complete sense because now I have a better idea of what it actually costs me to pay the bills and make a whiff of a profit.
So please feel free to download that, and feel free to let me know where you are at. What is that gap? Because once you see the gap between what you should be charging and what you are currently charging - you can't unsee it. But you know what the great thing is? Then you go, Alright, that's the gap. Let's say it's a $50 gap. Now you can make a plan around how I’m going to get over this gap? What do I need to do?
Another very common example of under billing is when people do increase their fees - but they only increase it for new clients. They go, I'm going to be really nice to my current clients because I love them and I love working with them, and they are amazing clients, they attend well, and I just don't feel comfortable asking them for more money. So I'm only going to do it with new people because they don't know that it was $20 cheaper last month. Right? So they're not going to be unhappy with me.
People, that's no way to run a business. That is running a business from an emotional point of view. And I know - we work in Allied Health, we work in mental health - there's a lot of emotion in the work that we do. But that is within the clinical space. And in order for you to continue working in the clinical space - for you to keep your doors open, and for you to ensure that your clinical team members are doing that important work - that they don't burn out - you have to increase your fees when the time comes, and you need to do it across the board. There's so many multiple reasons for that.
First and foremost - if you are increasing your fees, you're probably doing it because you have to, right? Because your costs have gone up. You need to pay your team more every year. You need to do repairs and maintenance in the offices where you're seeing people. These costs are running the business. And that cost should be recovered from all of your clients.
I don't know about you, but if I were one of your new clients walking in and I'm at reception and I've just paid $270 for my appointment, and then another client walks up and the reception says, “That's $250 for today.” My ears are going to perk up and I'm going to go, Hang on. Why are they paying $250, but I'm being charged $270? That's not right. And if I'm a new client, that's really going to impact the trust and my engagement with your service. Why take that risk?
And you might go, Oh, we are telehealth practice- people don't know that we are charging different rates. But still, it just doesn't sit well with me. I feel it's unfair. And maybe I'm bringing my emotions into it. But I also ask myself and especially having an in-person practice, I go - There's a real possibility that that could happen. And if that happens, am I ready, willing, and able to explain to that client why they are paying more than the other clients? Unless I am confident that my receptionist - because that's the poor person that's going to have to respond to that client - unless I've empowered them with an appropriate response, I don't do that. Because I don't want to put my receptionist in that position having to deal with that situation.
So again, if you go, No, I've got my reasons, Gerda. That's how I run it. Fine, but make sure that you protect the team that might need to deal with those clients. Also, be conscious of the potential fallout from new clients becoming really unhappy with that fact.
Another example of under billing is if you have an after-hours rate - but your team isn't charging it. I actually have a story around this one just to give you an idea of how this could happen. And it could happen so easily.
So at my practice, we charge after hours fees and a lot of the clients that I work with as a business coach charge after hours fees as well. I once spent a one-on-one session with one of my clients, and we track a lot of numbers when they work with me, and I noticed that the average session fee for the whole of practice had decreased - I think it was something like $20 to $30 from one month to the other. And I said, “There's something not right with these numbers. Did you guys actually work this out correctly?” Because maybe there was just a mistake in the calculation. So we sat, we worked it out - no, that is what the average session fee was for the previous month. So we went, Okay…
Now that we know that's the correct data, how do we explain this? Like how does your session rate just go down all of a sudden? This was at a practice where the majority of their work is private work, so - Medicare work. So sometimes you might have third party payers that bring your average session fee down. But as a general rule, a business would have the same amount of those types of referrals on a month-to-month basis. And you might even look at, you know, what percentage of the revenue is third party payers - that is maybe at a lower rate.
But at this practice, that was not the case. Like 95% of their work were Medicare clients and people paid a set fee. Anyway long story short, when we started to delve into the practice diary software, we noted that none of the after hour rates were being charged - for that whole previous month. What happened was that they had a new receptionist come on board that was doing the afternoon and evening shift. And yes, they was training for this person - but somewhere along the lines, something got missed in translation.
When a client would normally book a 10:00 AM appointment, the system then sees, Okay, 10:00 AM might cost $230, but then the client booked a 6:00 PM which now had to be $260. The reception just booked the client in at that time. But the system didn't automatically update the service item to “after hours” - that had to be done manually - so it never happened manually, which meant the client came in, they were just billed based on what would normally be a regular daytime appointment. Over the course of that month, they lost a shit ton of money.
That is an example of under billing. The other learning from that is that unless you track your average session fee - and lots of other numbers - on a month-to-month basis, you won't pick these things up. So it was great that we picked it up and we could immediately remedy it to make sure that the necessary training happens with that person, and make sure that the onboarding process was improved, to make sure that this never happens again.
Uncollected Client Debts
Last but not least, is the third usual suspect, and that is uncollected client debts. This is when you have already provided a service, but the client hasn't paid you. And again, there are people out there in our industry doing things in various different ways. Believe it or not, there's still a lot of people that see clients, invoice them manually and wait for the client to pay - and this could be Medicare clients, private paying clients - so they don't collect money at the time of the consult. The majority of times why people do that is they don't want to pay stripe fees. So they would rather get clients who do a direct bank transfer so they can save on the stripe fees.
And I get it - stripe fees are annoying - but you know, it's a cost of doing business. I don’t know why people get so tangled up in stripe fees. It's like, are you going to stop putting on the lights in the office? Are you going to stop using the air con in the office in summer? Are you going to stop paying for the internet because you don't like the fees associated with it? I don’t know why people look at stripe fees differently. It's just a cost of doing business.
This is actually a brilliant example of where people cut into the muscle. Not using Stripe is cutting into the muscle, because when you can easily bill somebody through Stripe, you are actually potentially saving money. You're saving it in terms of the time spent having to follow up people to pay. Because ask yourself - do people pay immediately? Some probably do, a lot don't. Reception needs to email them, call them, remind them. And then you have this worry about your cash flow, maybe struggling to pay your bills. It's not freaking worth it. But I digress. Let's get back to Uncollected client debts.
It's where you don't get paid at the time of providing the service, and this often happens with third party payers. So this example I just use are your clinical client payers, but majority of this is third parties such as WorkCover, Department of Veterans Affairs, EAP companies, Victims Assist, maybe NDIS plan managers, funding through your local Primary Healthcare Network - those are just the ones that immediately come to mind. If you're an OT working in aged care, there'll be home care packages and all of that type of stuff.
You need to be aware of what your age receivables at any point in time. So when you go into your practice software, you should be able to run an aged receivables report and it'll tell you what invoices are still unpaid and have been unpaid for 30 days, 60 days, 90 days, 120 days. Take it from me - these are the silent cash flow killers within your business. And also take it from me, that the longer they exist, the less likely you are to get paid. So you need to be really clear as to what is your acceptable percentage and dollar amount for aged receivables.
The problem with this stuff is that when you work with a third party, generally you do not get to set the terms and conditions. It would be great if we could, but let's face it - when you sign up with WorkCover or when you sign up with an EAP company, they will probably tell you, Hey, thank you for doing this work for us, we pay once every two weeks, or we pay you on the first of the month. They will have their own terms and conditions and 9 out of 10 times, they are the ones that set the terms and conditions. So you, as the provider needs to go, Am I happy to accept those terms and conditions? If you say yes - cool. But now you know, now you need to start planning that into your cash flow management, right?
But you still need to make sure that they pay you. So if somebody says they pay you every 30 days and it's sitting at 90 days, it's like, What's happening here? It shouldn't even get to freaking 90 days. This is where a lot of people slip up, okay? Not because we want to - just because we are busy with other stuff. You need to have a process in place to go, What are the Ts and Cs? What are the terms for each of our payers? How do we make sure that our invoices get there on time? What is the follow up? What is the in-house debt collection process that happens to ensure that we are the squeaky wheel and we get paid? Because if they've said the terms, but they're not sticking to it, we are going to let them know in a really nice and friendly and helpful manner.
If I were you, I would really get onto this, because if you think about it, this is work that has already been done. You have already done the work - or your clinicians - and you've probably paid your employee already. As a business, you have already incurred all the expenses involved in delivering the service. So make sure that you get paid. If you've not looked at this report for a long time - go and do that right now - because this should be the easiest money you ever make. Because you've already done the work. You need to get paid.
So to recap, our three usual suspects were: No-shows and Late Cancellations, Underbilling and Uncollected Client Debts. So have a think - which of these ones are really jumping out at you as something that you've not paid attention to - and go and get it sorted.
Also, don't forget - I will pop that link to the Excel spreadsheet in the show notes that will help you figure out exactly what your session fee should be at your practice.
Thank you so very much for joining me for this episode. I do hope that it has been of value, and as always, remember that I am here to help you build a practice you can't stop smiling about 😊