1:1 Coaching Application

1
Name* This field is required.
First Name
Last Name
2
E-mail* This field is required.
example@example.com
3
What is your practice name?* This field is required.
4
Where are you located?* This field is required.
5
Does your practice deliver evidence-based best practice treatment including real ear measurement and validated outcome measures, or are you prepared to start?* This field is required.
YESNO
6
What services do you currently offer in your practice?* This field is required.
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Large
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Ok
Ok
7
How many qualified treatment candidates do you see per month on average?* This field is required.
8
What is your current treatment acceptance rate (conversion)? Type "Unknown" if you aren't sure.* This field is required.
9
How many clinicians work in your practice, including the owner if applicable?* This field is required.
10
What was your practice's 2023 Gross Revenue?* This field is required.
11
What is your treatment revenue goal for 2024?* This field is required.
12
What is your biggest challenge in your practice right now?* This field is required.
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Small
Ok
Ok
13
What have you done so far to address it? How has it worked?* This field is required.
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Ok
14
1:1 coaching starts at $1500/month. Which best describes how you want to invest in your practice?* This field is required.Select the response that most accurately describes your willingness and ability to invest in coaching.
Please Select
Please Select
I don't have money or don't want to invest in my practice.
Things are tight, not sure if I can invest in my practice.
Things are tight, but I have resources I can pull from to create results in my practice.
I have resources and I'm ready to go all in with improving my practice.
15
What is your ideal outcome of working with Brad in 1:1 coaching?* This field is required.
16
Do you have 2-3 hours per week available (during or after clinic hours) to work on your practice?* This field is required.
17
Are you coachable, open to change, and committed to taking action to grow your practice and increase your owner independence?* This field is required.
Should be Empty: