Premier Pregnancy Practice (P3) Application

Application

IMPORTANT: Your application will be reviewed in the order it's received, so the sooner you submit it, the better your chances of being accepted. Questions? Email drkaren@pregchiro.com
Full Name *

Prefix First Name Last Name

Address *

Many updates and important information about this and other courses will be delivered via text and email. By providing that information, you agree to receive those messages. Rest assured, your privacy is ultra important and this personal information will not be shared, sold or rented EVER!
Cell Phone Number *

- Area Code Phone Number
E-mail *
Website Address *
How many years have you been in practice? *
How many pregnant patients do you average each week? *
Tell me about your practice as it is right now, including how much revenue you've generated and how many pregnant patients you've served in the last 6 months
What do you want your practice to look like next year?
Why do you want to join the Premier Pregnancy Practice with Dr. Karen Gardner?
What are you struggling with right now in your practice?
What have you tried to do to fix it? Why do you think it isn't working?
Why do you feel you would be the right fit for this experience and what value will you bring to this group?
Why should you be considered above all other applicants?
Is there anything else Dr. Karen should know that will help her make the right decision?
What income goal would you like support in reaching over the next 12 months?
Should be Empty: