Gamechanger Application

1

What's Your Name?* This field is required.

First Name

Last Name

2

What's Your Email address?* This field is required.

example@example.com

3

Best Phone Number to Contact You?* This field is required.We we call you at this number for your appointment.

Area Code

Phone Number

4

How Old Are You?* This field is required.

5

Are you married and do you have children that you want to build and leave a Legacy for?* This field is required.Select all that apply.

I am Married.

I have Children that I want to build and leave a legacy for

Neither

6

Is your Chiropractic Practice your Primary Source of Income?* This field is required.

Yes

No, I have other sources of income that outweigh my Practice.

7

What is the estimated Annual Revenue of your Businesses/Practice ?* This field is required.

$0 - $100,000

$100,000 - $250,000

$250,000 - $500,000

$500,000 - $1,000,000

$1,000,000+

8

What content of Gamechanger have you consumed?* This field is required.

Visited our Website

Challenge Participant

Free Training on Facebook

"Change The Game" The Podcast

I haven't consumed any content and I don't know much about Gamechanger or Dr. Buffington

9

Briefly describe your business.* This field is required.

10

Do you find yourself often stressed out and overwhelmed with the responsibility of Business, Marriage, and Family?* This field is required.

YESNO

11

How many Hours do you work per week on Average?* This field is required.

12

Do you Trust yourself to make Hard Decisions?* This field is required.

YESNO

13

Do you have any people in your life that you truly trust and feel you could share anything with, who would not judge you at all but be there to support you?* This field is required.

YESNO

14

What is the Biggest Problem you are facing?* This field is required.Select ALL That APPLY!

Cashflow(lack of revenue)

Overhead too high and/or don't know my numbers

Too few new patients, lack of patient follow through, ...

Relationships (Marriage, Children, Parents, Business Partners, etc.)

Stress

Trusting Myself to Make the Right Decisions

Balancing Business, Marriage, & My Family

My Leadership Ability (or lack thereof)

15

How do you feel about your business overall today?* This field is required.

My Business is WORKINGMy Business is NOT WORKING

16

Are you hitting your personal take home income goals right now?* This field is required.

YesNo

17

Is there anyone else (spouse / partner) that needs to be on this call with us?* This field is required.(If answering "YES" please bring ALL other decisions makers onto the call with you)

YesNo

18

How willing and able are you to invest in solving the problems you currently face?

I have the financial resources to solve these problems

I have access to the financial resources needed to solve these problems

I don't have any financial resources to solve these problems right now

19

What is your current annual revenue?* This field is required.

Choose an option from the dropdown menu

20

Are you currently in a position to invest in your business?* This field is required.

Yes, I have access to the financial resources needed to solve these problems.

No, I'm maxed out and have no financial resources.

21

If you're accepted into Gamechanger, how soon can you get started?* This field is required.

Immediately! No Rush - I don't really care.

22

Finally, Why does it matter that you solve the problems you face? What Drives you?* This field is required.(This is an important question)

23

Gamechanger is filled with successful Chiropractors who work together closely and share extremely valuable personal and business information about what is working and not working for them. Why do you feel you're a good fit for this brotherhood and what will you bring to our group?* This field is required.(This is an important question)

24

Campaign

25

utm_medium

26

Ad

27

If a trusted friend or mentor advised me to invest $10,000 - $30,000 on a trainer, mentor, or mastermind that would not only add another $100,000 a year in profits to my business but protect me from making massive mistakes in business, marriage, and family, I would...

Jump at the opportunity because I realize that being able to add $100k in profits to my Practice while at the same time surrounding myself with elite and experienced Chiros who have built successful practices with shorten my path to RESULTS I want quickly.

Be nervous and excited all at the same time but I know what's at stake if I don't fix my practice and/or life and I am committed to doing whatever is required.

I don't see this as an investment in my life or my practice and don't see any value in surrounding myself with the right people that are where I want to be in life and will help me get there at a much faster rate.