AI Voice Agent Build (Vapi/Retell + Twilio), EHR Scheduling and CRM Integration

We are a healthcare technology firm hiring a developer to build an AI voice front office and patient outreach system for our client, a four-location aesthetics, dermatology, and plastic surgery group in the Midwest. We are the client. You work for us. You do not contact the practice. WE WANT ONE FIXED PRICE FOR THE ENTIRE BUILD. Not hourly. Not a range. Not split into stages. One number you will stand behind, plus the rate card and contingency pricing described below, so that anything outside the baseline is already priced and never has to be renegotiated. READ THE SUBMISSION REQUIREMENTS AT THE BOTTOM BEFORE YOU WRITE ANYTHING. We require an attached document structured to this post. Generic proposals and capability decks are not read. BASELINE Bid against exactly these limits. If the real build exceeds one, we pay the rate you quote in section C. Nothing here is a guess on your part. Locations: 4 Bookable providers: up to 15 Appointment types: up to 25 across all providers Distinct call intents: up to 12 Call scripts supplied by us: 2 (new patient, existing patient), up to 6 pages combined Language: English only Inbound call volume: up to 1,500 per month Outbound messages: up to 10,000 per month combined across confirmations, recall, reactivation, and intake reminders Outbound calls: up to 1,000 per month Business hours: one shared schedule across all four locations THEIR STACK EHR / practice management: Nextech. Open REST API available to the practice on request for a fee. The practice has not yet purchased API access. See section D. CRM and messaging: GoHighLevel, currently migrating to Nextech's white-labeled GoHighLevel instance. Migration is in progress and not complete. Telephony: Snet VoIP. One number rings all four locations at once and whoever is free answers. Online booking: moving from a third-party tool to Nextech's built-in booking. VOLUMES, AS STATED BY THE PRACTICE 1,200 to 1,300 calls per month. This is their own adjusted figure. Their raw VoIP logs multiply each call by up to four because of the all-locations ring, so do not size against raw logs. 64 percent of calls currently unanswered. Roughly 350 new leads per month, a significant share arriving as inbound text. After hours: 20 to 40 hangups or voicemails per weekend, roughly 5 per weeknight. Daily appointment confirmations: roughly 160 to 240 patients per day across all locations. Recall and reactivation outreach: 100 plus touches per day, currently manual. SCOPE Voice handling 1. Answer every inbound call within one ring, 24/7, across all four locations, using scripts we supply. Scripts must be editable by us without a ticket. 2. Identify new versus existing caller and route accordingly. 3. Confirm details back at the end of the call, with repetition level configurable. Over-confirming is a stated dealbreaker for this client. Show us how it is tuned. 4. Warm transfer to a live person during business hours, routed by intent to a designated staff member, with fallback. Transfer targets editable by us. 5. After hours: take a message or capture booking intent, caller's choice. 6. Emergency notice on every after-hours interaction directing medical emergencies to hang up and dial 911. Fires before anything else after hours. 7. One queryable record per call, inception to termination. Every call produces a single record: how it arrived, how it was routed, every path taken including transfers, who handled each portion, outcome, and where it terminated. Segmented recordings are fine if each segment carries the same call ID and the full call can be retrieved and reviewed as one item. What we will not accept is a transfer that leaves no record of the human portion. Scheduling, two-way with the EHR 8. Read live availability across all locations, providers, and appointment types. 9. Book, reschedule, and cancel written directly into the EHR. 10. Create the patient record with the fields their intake flow requires at minimum: date of birth, email, phone, address. Records missing these will not save. 11. Confirmation by text and email after any booking or change. Intake follow-through 12. The EHR sends a patient-completed intake link automatically once a record is saved. The patient always completes their own medical intake. You are not capturing clinical intake. 13. Read the EHR's intake registration status, reported by the practice as a registered or not registered state with an activity report. Send a reminder with the link when incomplete, and an arrive-early instruction when a reminder has not produced completion before the appointment. Tell us how you would detect this state and whether you would poll or use a webhook. Webhook availability is unconfirmed. Outbound patient outreach 14. Automate daily appointment confirmations across all locations. 15. Automate recall and reactivation. Aging logic on last appointment date and last contact date, configurable thresholds, text-first with call fallback, at 100 plus touches per day. 16. Capture every inbound lead regardless of channel into the CRM as a tracked record with a terminal outcome. We must be able to see whether a given lead booked and where it was routed. Reliability and cutover 17. Failover. If your platform, the model provider, or any dependency becomes unavailable, inbound calls must fall through to the practice's existing ring group automatically and without manual intervention. Their phone line is their revenue. A dead line is not an acceptable failure mode under any circumstance. Describe your failover path, how quickly it triggers, and how it is tested. 18. Monitoring and alerting. We are notified when the system is degraded or down, and we are notified before the practice notices. State what you monitor and how alerts reach us. 19. Number strategy. Tell us your recommendation and why: does the assistant take over the practice's published main number directly, or does it sit on a new number that the existing number forwards to? Address what each option means for failover and for reversing course if the practice wants to pull back. 20. Test environment and cutover plan. The assistant does not go live on real patient calls without a tested build. Provide a test number and environment we can exercise against real scenarios before cutover, and a written go-live plan including how we roll back inside one business day if something is wrong. Include the time required for this in your timeline. Reporting 21. Dashboard: call volume, answered versus unanswered, intent breakdown, bookings created, transfers, after-hours activity, lead source and outcome, confirmation and recall performance. Filterable by location and provider. Click through to the individual call record and its recording. Exact layout is open, so show us your standard. DELIVERY SEQUENCE Start with everything that does not depend on EHR access: call answering, routing, transfers, after-hours handling, message and lead capture, and the dashboard. Connect the EHR-dependent items when access is granted. This is a sequencing instruction, not a change to the price or the scope. One fixed price covers all 21 items. Give us one delivery timeline with the EHR connection marked as a dependency on it. PRICING: EXACTLY WHAT TO SUBMIT A. One fixed price for items 1 through 21. B. Monthly running cost estimate, itemized: telephony, speech, LLM, SMS, hosting. State your assumptions on average call length and transfer rate. We pass these costs through at cost and do not mark them up, so a bad estimate hurts us directly. C. Rate card. Quote each now. Together with section D these are the only things that can change the price after award. - Per additional bookable provider beyond 15 - Per additional appointment type beyond 25 - Per additional call intent beyond 12 - Per additional page of script branching beyond 6 - Spanish language capability, if later required - Per-location business hours instead of one shared schedule - Sustained outbound volume above the baseline, stated per 1,000 messages and per 1,000 calls - Your hourly rate for anything we request that is not on this list D. Contingency pricing for two named unknowns. We do not have this information and will not have it before award. Price both outcomes now. 1. EHR scheduling write. We have not confirmed the practice's API tier supports appointment writes. Quote assuming write access is available, then quote your fallback if it turns out read-only, and describe what that fallback is. 2. Existing call recording. We do not know whether their VoIP provider records today or where those recordings are held. Tell us what changes in your approach and price under each scenario. E. Monthly support after the acceptance period. What it covers, response times, and what falls outside it. Quote now. We will not negotiate it after award. F. Optional modules, priced separately from the fixed price. Call analyzer. Scores every inbound call and every staff member handling calls: booking and conversion rate by person, reasons calls did not convert, talk-time and silence analysis, flagged calls, with playback, scored against criteria we supply. Schedule-gap campaign engine. Reads the schedule, identifies underbooked providers and open slots, and executes a targeted SMS offer against a patient segment. We define campaigns monthly. You build the engine. FIXED PRICE TERMS Your number covers discovery, build, integration, testing, revisions during acceptance, documentation, and handover. Your own estimating error is inside your number. The only things that change the price are the rate card in section C, the contingencies in section D, and scope we add in writing. Acceptance: the build is accepted when it performs items 1 through 21 against the baseline in live conditions for 30 consecutive days. Defects found in that window are yours to fix at no charge. Functionality we did not ask for is a rate card item. Client-caused delay: the practice controls their own EHR access, credentials, scripts, and provider list. If they are slow, that is our problem and not yours, and it will not be held against your timeline. It also does not entitle you to reprice. Your quoted price is valid for 6 months from award. State that you accept these terms. A bidder who skips this section is telling us they intend to revisit the number later. THE PRACTICE DOES NOT LEARN A NEW SYSTEM This is an architectural requirement. The EHR is the system of record for appointments and patient data. No parallel database that staff would have to reconcile. Patient messaging and lead records write into the CRM they already use. No separate inbox and no separate lead queue. The only new interface for the practice is the read-only dashboard. The configuration layer is ours. The practice never opens it and needs no login for it. If your architecture requires them to learn a new screen or add a step to an existing workflow, name it in your bid. COMPLIANCE Appointment details, recall messages, and call recordings for a medical practice are protected health information. Every vendor in your proposed stack must sign a BAA at no additional monthly surcharge. Name each vendor and confirm this. Some voice platforms gate HIPAA behind a four-figure monthly add-on. If that is your stack, say so plainly and we will read your monthly cost accordingly. Recordings and transcripts need configurable retention. We set the policy and the system enforces it. The greeting will carry a recording disclosure. We supply the wording. Treat it as a script element. CONTROL AND OWNERSHIP State your agreement to each. Raise disagreement now, not after award. 1. All new service accounts open in our name with us as owner: voice platform, telephony, SMS, hosting, monitoring. You get admin access. Usage does not bill through your invoice. 2. Credentials to the practice's systems are held by us and granted to you for the duration of the work. 3. Source code, prompts, configuration, and documentation are ours, delivered as built rather than at the end. 4. We change scripts, prompts, routing, hours, transfer targets, escalation paths, repetition level, and outreach thresholds without opening a ticket with you. Describe how you enable that. 5. No architectural lock-in. Tell us honestly where it exists in your stack. 6. You do not contact the practice. You may join calls with their EHR or IT vendor when we ask. 7. Documented handover to us or a successor developer at a defined rate if either side ends the relationship. OUT OF SCOPE Answer engine optimization, SEO, website work, paid media, clinical scribing, and replacing anything the practice currently runs. ANSWER THESE IN YOUR PROPOSAL 1. Your direct experience with the Nextech API: which endpoints, what worked, and whether scheduling writes were available. If you have not worked with Nextech, say so and name comparable EHR write integrations you have shipped. 2. Your experience with GoHighLevel, and how you would insulate the build from a CRM migration that is still in progress. 3. Your experience with Snet or comparable SIP-based VoIP, and how you insert an AI layer without disrupting a four-location ring group. If you have not worked with Snet specifically, tell us what you would need to confirm about their setup before committing to your price. 4. Two or three live deployments with a number we can call. We will call them. 5. Your approach to repetition tuning and interruption handling, with an example. 6. Where does the data of record live? What sits in the EHR, what sits in the CRM, and what sits in a database you control. 7. Who is doing the work. Name the team and its location. Name any subcontracted portion. 8. We are not engineers. Will you join calls with the practice's EHR and IT vendors as our technical representative and explain trade-offs in plain English? Answer honestly. Some good developers do not want that role and that is fine, but we need to know now. 9. What is underspecified in this post? A bidder who takes it at face value is telling us something. HOW TO SUBMIT YOUR BID Attach a document. PDF or Word. The Upwork message field is for a short note only, not for your proposal. Your document must be structured in the following numbered order, using these exact headings. We are comparing bids line by line against each other, and a proposal in any other structure cannot be compared, so it will not be read. 1. FIXED PRICE One number for items 1 through 21. 2. MONTHLY RUNNING COST Itemized: telephony, speech, LLM, SMS, hosting. State your assumed average call length and your assumed transfer rate. Show the arithmetic. 3. RATE CARD All eight lines from section C, each with a number. Write "not applicable" only where it genuinely is, and say why. 4. CONTINGENCY PRICING Both scenarios from section D, each priced, each with your approach described. 5. MONTHLY SUPPORT Figure, coverage, response times, exclusions. 6. OPTIONAL MODULES Call analyzer and schedule-gap campaign engine, priced separately. 7. DELIVERY TIMELINE One timeline in weeks, with the EHR connection marked as a dependency. 8. FIXED PRICE TERMS State plainly that you accept the fixed price terms as written, or name the specific item you cannot accept and why. 9. CONTROL AND OWNERSHIP Respond to all seven numbered points individually. "Agreed" is a sufficient answer to a point you accept. 10. PROPOSAL QUESTIONS Answer all nine, numbered to match. What we do not want: company overviews, capability decks, service catalogs, team bios beyond what question 7 asks, case studies for projects unlike this one, or any text that would read identically in a proposal to a different client. If a paragraph in your document could be pasted into another bid unchanged, delete it. We would rather read four pages that address this build than forty pages about your company. We are reviewing bids on a rolling basis and will begin shortlisting within one week of posting. Bids that skip the rate card, the contingency pricing, or the control and ownership section will be passed over.