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PEAK Student Application
Apply here and we'll follow up within 5 business days!
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
How did you hear about us?
*
Please Select one
Google
Friend/Family
Social Media
Provider
Other (Please specify...)
What quarter are you looking to begin PEAK?
*
Fall 2023
Winter 2024
Spring 2024
Other
Our practice requires a 6-month PEAK commitment. Is this feasible for you?
*
Yes
No
Do you have interest in pediatric and pregnancy chiropractic?
*
Yes
No
Are you familiar with PX?
*
Yes
No
As a PEAK student, you will be trained and expected to perform the following:
Answering phones, scheduling patients, playing with and holding babies/kids, basic cleanup, CLA INSiGHT scans, ROF preparation, new patient consultation, and more! Adjustments are performed outside of our clinic in a women's shelter to help get your adjusting numbers.
Do you understand what will be expected of you?
*
Yes
No
Please tell us a little bit about you, your goals, and why you'd like to become a PEAK student in our practice:
*
What questions do you have for us, if any?
By submitting this form, you're giving Cumming Family Chiropractic permission to subscribe you to our newsletter as well as contact you via email or phone when enrollment opens. Do you consent?
*
Yes
I've changed my mind, just add me to the newsletter (this will NOT add you to our PEAK application list)
No
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