MIFAS Accelerator Application

1
Let's get started... What is your name?* This field is required.
First Name
Last Name
2
What is your Email?* This field is required.
example@example.com
3
Mobile Phone Number?* This field is required.
4
What is your practice website url? (if none, please type "none")* This field is required.If you don't have one, please type "no website"
5
What is your current estimated monthly revenue?* This field is required.
6
What is your target monthly revenue?* This field is required.
7
What do you feel is your biggest obstacle to hitting your monthly revenue goal?* This field is required.
8
How comfortable are you in MIS procedures currently?* This field is required.
I have never performed MIS procedures as of yet.
I have performed some soft tissue procedures.
I have done soft tissue and some simple exostectomy procedures.
I have performed soft tissues and MIS osteotomies but I want to improve more skills.
9
How willing are you to invest in implementing MIS and growing your practice right now?* This field is required.
1
2
3
4
5
Conservative
Agressive
Should be Empty: