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Preparation for Appointment

Please fill out this form so I can prepare for your appointment.

Without an application form from you 24hrs before your appointment, it's difficult to help you to the best of my abilities. We would have to cancel your call and reschedule.

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Question 1 of 19

What is your first and last name?

Question 2 of 19

What is your email and phone number (including country and area code)?

Question 3 of 19

How did you hear about me and my 6 month program?

Question 4 of 19

Which age bracket are you in?

A

20-29

B

30-39

C

40-49

D

50-59

E

60+

Question 5 of 19

What is your current biggest frustration with being in practice?

Question 6 of 19

What are 2 things that you struggle with the most in the day-to-day application of your practice?

Question 7 of 19

If I had a magic wand and could fix one thing in the way you practice what would that be?

Question 8 of 19

Why do you think that you are a good candidate for clinical practice mentoring?

Question 9 of 19

What goals would you like to achieve in the next 6-12 months of your career?

Question 10 of 19

With regards to your clinical practice, what is the number one thing you NEED right now?

Question 11 of 19

Concerning your clinical practice, what is your biggest fear?

Question 12 of 19

What do you think is your biggest obstacle to you achieving these goals?

Question 13 of 19

Right now I....

 

A

Have the financial resources to invest in myself and my short & long term goals.

B

Have access to the financial resources to invest in myself and my short & long term goals.

C

I don't have any financial resources at all, and I'm going to have to keep working on my career as is.

Question 14 of 19

If someone advised me to spend $2,000-6,000 on a coaching program to help me achieve my career goals, gain confidence, and improve my income, I would...

A

Know it's what any serious and committed Therapist needs to do to achieve success in practice.

B

Be a little cautious, yet with a proven system I would do it because I'm serious about being successful.

C

Avoid at all costs, because I need/want to do things as cheaply as possible.

Question 15 of 19

I believe working with a qualified and experienced Osteopath is a worthwhile investment.

A

Yes

B

No

Question 16 of 19

Given that I am happy, confident, and have no further questions about working together, I would be immediately ready to make the investment and begin the journey towards successful practice.

A

Yes

B

No

Question 17 of 19

How serious are you about improving your practice, and when do you plan to start?

A

Very serious - I'm ready to start right away.

B

Somewhat serious - I can start in the next few weeks.

C

Just exploring - I'm not ready to improve my practice just yet.

Question 18 of 19

I will call you at the time you chose. Please commit to your appointment time by typing this sentence in the box below: "Yes, I promise I will answer the phone/video for my Success in Practice strategy appointment".

Question 19 of 19

Finally, what is your biggest strength...what are you great at? And why did you choose to be in this profession?

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