Do you own a practice?
*
Yes
No
What type of practice do you own?
*
Physical Therapy
Chiropractic
Dental
Podiatry
Osteopathy
Speech Pathologist
Multidisciplinary
Acupuncture
Exercise Physiology
Massage Therapy
Vet
Others
I don't own a practice
If you selected 'other' what practice do you own?
How long have you been running your business?
*
Less than 1 year
2-4 Years
4-8 Years
More than 10 Years
How many people are on your team?
*
Just me
1-3
4-10
More than 10
What is your current revenue per year?
*
0-100K
250K-500K
250K -500K
500K - 1M
1M+
What is your goal for annual revenue in 12 months time?
*
Which of the following is your biggest roadblock that is slowing you down?
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I don't have enough new patients
My business is too dependent on me
My patients cancel or drop out of treatment too soon
All of the above
If we were talking in 12 months from now... What would your ideal business look like?
*
What is your website? Enter URL here:
First Name
*
Last Name
*
What is your best email?
*
example@example.com
Where are you located?
*
USA/Canada (+1)
UK (+44)
Australia (+61)
New Zealand (+64)
Africa (+27)
What's the best phone number to call?
*
Are you sole owner or do you have a partner?
Can you handle an influx of new patients?
Yes
No
Have you ever hired a coach to help you with your business?
Yes
No
What type of practice do you own?
*
Eg. Physical Therapy, Dental, Podiatry, Chiropractor, etc.
*
By submitting this form, I confirm I own my own Practice and I’m a Physical Therapist, Podiatrist, Dentist or Chiropractor.
*
By checking this box, I agree to Practice Acceleration's Privacy Policy, Terms and Conditions and for Practice Acceleration to communicate with me via my supplied email and phone number. https://practiceacceleration.com/privacy
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*
By submitting this form, I confirm I own my own Practice and I’m a Physical Therapist, Podiatrist, Dentist or Chiropractor.
By checking this box, I agree to Practice Acceleration's Privacy Policy, Terms and Conditions and for Practice Acceleration to communicate with me via my supplied email and phone number. https://practiceacceleration.com/privacy
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