1.) Please enter your First Name
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2.) Please enter your Last Name
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3.) Please enter the name of your practice/organization
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4.) Please enter your E-mail
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5.) Please enter your Phone No.
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6.) Why did you become a Chiropractor? (Tell me your story)
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7.) What is your definition of success as a Chiropractor and why is that important to you?
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8.) What is your mission as a Chiropractor and why?
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9.) What is the #1 problem stopping your from reaching this mission?
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10.) What is your vision for how you will impact the world and why do you want to do that?
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11.) What is the #1 challenge to achieving your vision?
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12.) How many patients are you currently seeing each week?
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13.) How many patients would you like to see each week?
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14.) How many locations do you currently run and where are they located?
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15.) How many locations would you like to run and where?
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16.) How many employees are on your staff?
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17.) Do you have any associate DC’s and if so, how many?
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18.) Would you like to have an associate program and why?
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19.) How do you attract new patients to your practice?
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20.) How do you convert new patients to lifetime patients?
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21.) Do you accept insurance and what percentage of your patients pay with insurance?
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22.) Do you have cash patients and what percentage of your patients pay cash?
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23.) What is your definition of financial success?
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24.) Why is financial success important to you?
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25.) What is the risk if you do NOT achieve financial success?
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26.) Do you have a desire to be remarkable?
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27.) Are you willing to DO remarkable in order to BE remarkable?
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28.) Do you have the time to commit to creating a remarkable LIFE?
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29.) Are you willing to invest financially in creating your success?
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30.) If you were selected for 1-on-1 coaching, would you commit to following the system, completing your assignments and sticking it out when the going gets tough?
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31.) Why do you feel that you might be a better candidate than others for 1-on-1 coaching?
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32.) Why do you need coaching to reach your dreams?
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33.) What area of your practice needs the most work?
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34.) What area of your life needs the most work?
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35.) What are you willing to do to achieve success?
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36.) What are you NOT willing to do to achieve success?
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37.) What kind of a legacy do you want to build and why?
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38.) What could stop you from building the legacy you desire?
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39.) What is the danger of you NOT achieving your mission, vision and legacy?
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40.) How important is your family to your mission, vision and legacy?
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41.) What is the biggest threat to your family’s well-being?
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42.) When you die, how do you want to be remembered?
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Should be Empty: