Dr Michael Gaeta's Clinicians Mastermind Circle
Email address *
Full Name *
Your answer
How did you hear about this program? *
Your answer
Licenses / Certifications / Degrees *
Your answer
Tell me about a little about your practice (years open, average number of patients per week, type of offerings): *
Your answer
What are the current MONTHLY gross revenues for your practice? *
What’s the difference between your current and ideal practice? *
Your answer
Why haven't you been able to reach your practice goals yet? *
Your answer
What would mean IDEAL success for you, as we work together to improve your clinical skills and grow your practice in 2017? *
Your answer
What is the main focus in the coming year for you? *
Which is true for you? *
Which best describes you? *
I can commit to at least three hours of study per week, as an investment in myself, so that I can have a positive transformation for myself and my practice. *
I am comfortable using technology on my own: operating a computer, e-mail, web browsing, copy and paste, logging into websites with a User ID and password. These basic skills are necessary to fully use and benefit from this Program. *
If you are selected for Clinician's Mastermind Circle, how soon can you enroll? *
What is your clinic website address?
Your answer
What is your Skype ID?
Your answer
What is the best phone number for us to reach you? *
Your answer
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