Apply to the House Call Practice Program

1
What's your profession?
2
Where are you located?
3
What is your current practice situation?* This field is required.
Associate/Employed
Independent Contractor
Practice Owner
4
How many years have you been practicing?
5
What’s your primary motivation to transition to a house call practice?* This field is required.Share what is really calling you to make a powerful change.
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What challenges are you currently facing in your practice?* This field is required.Be brutally honest. What isn't working for you?
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How are these challenges affecting your life?* This field is required.Detail how your current practice situation is affecting your lifestyle, mental state, physical health, happiness, and day-to-day well-being. Consider the broader consequences—relationships, career, health.
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Complete this sentence: "The traditional practice model isn’t working for me because ________________________________."
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Why is it necessary for you to change your practice model now?
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What blocks or fears do you have about building your own house call practice? (Select all that apply):* This field is required.
Fear of failure
Feeling trapped
Lack of confidence in my abilities
Burned out
Currently struggling in practice
Concern about not attracting enough patients
Worry about financial instability
Doubt about my practice management skills
Concern about not attracting enough patients
Have a hard time setting boundaries
Fear of competition
Fear of increasing my fees
Stressed about marketing and promoting my practice
Hesitation about leaving my current job
Fear of transitioning my current practice
Concern about work-life balance
Already burned out
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Why are you motivated to overcome those fears?* This field is required.
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What are your top three goals for building a house call practice?* This field is required.
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What specific outcomes do you hope to achieve by completing the House Call Practice Program?* This field is required.
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What are your financial goals in the next 12 months?* This field is required.
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How will meeting those financial goals change your lifestyle?* This field is required.
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Is there anything else you'd like me to know about your situation or goals?* This field is required.
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What methods or programs have you tried before, and why do you think they didn’t work for you?
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What are you willing to do to transform your practice and life?* This field is required.Define the lengths you're prepared to go to for a real, lasting change.
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On a scale of 1-10, how committed are you to actively participating in the House Call Practice Program and doing the necessary work for your healing and growth? (1 being not committed, 10 being fully committed)* This field is required.
20
I understand that this requires a significant investment in my personal transformation, practice management, time, mental energy, and finances, and I am 100% committed to changing my practice model.* This field is required.
Yes, I am fully committed to investing in my growth and success.
No, I am not ready to commit to changing my practice model.
21
What's your name?* This field is required.
First Name
Last Name
22
What's your email address?* This field is required.We will use this to reply to you.
example@example.com
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What's your phone number?* This field is required.We'll use this to send you updates to your application status.
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