When you go from one therapist in one office to 20 across four locations, the systems that used to work start breaking down. At Miracle Farm Speech Therapy, that breaking point came with a stack of carbon copy notes, a Google spreadsheet no one fully trusted, and a therapist who showed up to treat—only to find there wasn't a room available.
The Challenge
Miracle Farm Speech Therapy started small: one practice owner, one location in Hampton Falls, New Hampshire. Growth came quickly. Interns became full-time therapists. One office became two, then four. The practice also took on school district contracts alongside its private caseload—and schedules shifted twice a year to accommodate summer and fall transitions.
The tools that worked for a handful of therapists couldn't keep up.
"We tried to do it just in a Google spreadsheet," says Ashley, who manages operations at the practice. "You never really knew who was where. You never really wanted things to be uncomfortable for you or for your client—if you showed up to an office, there wasn't a room for you to treat in. Which happened to me several times. There's got to be a better way to do it."
Clinical documentation was entirely on paper. Carbon copy notes—one for the family, one for the back office—worked fine when the team was small. But with growth came risk.
"As things got bigger, it got too difficult. Creating a physical and a literal paper trail—you were more likely to misplace or lose documentation, and then not be secure."
The back office felt it most. Staff chased down paperwork across four locations. Reports lived in email chains. Billing coordination meant tracking down carbon copies that may or may not have made it to the right desk.
"It felt like the back office was always kind of chasing down paperwork," Ashley recalls. "There was an email—'Hey, I need this report for this kid. Where is it? Do you have it done yet?'"
Finding ClinicNote
Ashley spearheaded the search for an EMR, running a cost-benefit analysis across several platforms. For a practice with upwards of 20 users, cost was a real concern.
"EMRs can be quite expensive, and with upwards of 20 users, that's a pretty large cost to assume. We're technically still a small business."
But cost wasn't the only factor. A client portal was important so families could see upcoming appointments and access documentation. And one requirement was non-negotiable: a dual-signature workflow for clinical fellows.
"In the state of New Hampshire, you cannot have a clinical fellow independently sign off on documentation for certain insurances and Medicaid," Ashley explains. "So it was really important to have a dual signature option and some sort of approval process—a senior therapist approving a clinical fellow's documentation."
After evaluating options including Simple Practice, ClinicNote checked every box. Clinical fellows could be set up as student therapists, with a built-in supervision workflow that matched New Hampshire's regulatory requirements. Once they earned full certification, transitioning them to supervising therapist status was seamless.
Implementation and Onboarding
The biggest concern going in? Migration. The back office had to prepare 300 to 400 client records for upload—and they were understandably nervous.
"Our back office was more petrified," Ashley says. "They had their systems. I think they were really hesitant in transferring that information. But I think that was the biggest feat."
Ashley ran trainings for the initial team of about 15 therapists, combining ClinicNote's built-in help guides with practice-specific instruction—custom templates, attendance settings, room configurations, and how to set up school district clients differently from private practice cases.
That onboarding process became a lasting part of how the practice operates. To this day, every new hire gets a one-hour walkthrough.
The biggest learning curve wasn't the software itself. It was rethinking the end of a session.
"Therapists were so used to doing something quick—it could be done in less than five minutes on the carbon copy, handwritten," Ashley explains. "So I think the biggest thing was trying to re-envision how the end of your session looked."
Some therapists carved out the last five minutes of a session for documentation. With younger kids, that wasn't always an option. Everyone found their rhythm.
The Results
With time on the platform, the benefits have compounded.
Scheduling clarity across four locations. No more guessing who's where. Therapists, rooms, and availability are all visible in one place—making it easy to optimize schedules, place new clients, and prevent room conflicts.
Streamlined billing and documentation. Reports go straight into the system. The back office knows exactly where to find them. The days of chasing down paperwork via email aren't completely gone—but they're the exception, not the rule.
"At least now they know where to go first," Ashley says. "It's not just kind of chasing that down."
Faster adoption for new hires. An interesting pattern emerged: therapists who'd been with the practice longer had the hardest time transitioning. New hires? No adjustment period at all.
"There was no transition time," Ashley says. "It's just something they adopted. And now we're seeing more therapists come out of their education with some sort of electronic medical record experience—so they're already accustomed to something similar."
Data-driven business decisions. With clear visibility into each location's utilization, the practice can now make informed choices about where to invest—and where to cut back.
"We have one office location where not a lot of therapists are seeing clients, and there's not a huge desire to be seen at that office. In the next couple months, that might be a business decision—is this office just kind of a waste of money financially for us? Could we use those funds to expand on a busier location?"
Looking Ahead
Miracle Farm Speech Therapy continues to grow, and ClinicNote grows with it. What started as a solution for scheduling chaos and paper-based documentation has become the operational backbone of a multi-location practice—giving the team the visibility, structure, and confidence to make smart decisions about where to go next.
About Miracle Farm Speech Therapy
Miracle Farm Speech Therapy is a speech-language pathology private practice based in Hampton Falls, New Hampshire, with four office locations and approximately 20 therapists. The practice serves both private clients and school district contracts.
"You never really wanted things to be uncomfortable for you or for your client. There's got to be a better way to do it."
— Ashley Kelley, Miracle Farm Speech Therapy