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Question 1 of 11

What prompted you to contact Elite Chiropractic Coaching?

Question 2 of 11

Do you practice corrective care?

Question 3 of 11

What challenge(s)/problems would you like to resolve?

Question 4 of 11

How is this/these challenge(s) affecting your practice/you reaching your vision for you practice?

Question 5 of 11

How do you feel/what emotions are you experiencing because of this/these challenge(s)?

Question 6 of 11

What is your motivation/inspiration to make a change/learn something new to take you to the next level in your practice and life?

Question 7 of 11

Please provide us with your Practice Stats

(Avg Gross Collections Per Month/Avg New Patients Per Month/Avg Office Visits Per Week)

Question 8 of 11

What does your ideal practice look like? What does it feel like to have this practice in the near future?

(It's your 10 out of 10 practice and vision for your life).

Question 9 of 11

On a scale of 1-10, how committed are you to your results/vision? Why?

Question 10 of 11

What is the ONE this that is standing between you and your goal/vision? What are you willing to do to overcome this?

Question 11 of 11

Contact information of your practice

(Name of Practice, Address, Office Phone, Office Email)

Confirm and Submit