Auni ILIT Learning Network Membership Application

Thank you for your interest in the Auni® ILIT™ Learning Network (AILN).

It is the only network of its kind for allergist physicians who want to plug-and-play the ILIT™ procedure into their practices for building patient-first, profitable businesses, so they have the freedom to live life and practice medicine on their terms.

This is a training and licensing program that will give you the expert training, proprietary methods, coaching, accountability, resources, and community you need to build a thriving ILIT™ business within your existing practice.

This Network is the most inspiring and supportive community of ILIT™ allergists in the WORLD.

If you have any questions, please contact us at ILIT@auniallergy.com

We cannot wait to work with you!

Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Phone *
Name of practice or educational institution *
Practice or institution website *

What is the biggest challenge you are facing in your practice right now?
*
Why do you want to join the Auni® ILIT™ Learning Network? Please be thorough in your answer.
*
How many SCIT or SLIT patients do you currently manage?
*
What was your total revenue last year?
What is your projected revenue for the current year?
Where do you see yourself in the next 3-5 years? 
*
Have you worked with a Healthcare Learning Network or partnered with a medical licensing program before?
Clear selection
How was your experience?
What percentage of your patients that could benefit from allergen immunotherapy (AIT) choose not to start AIT because of the time commitment or inconvenience? *
In the past year, how much have you invested in your personal and career development?
*
What is your long-term vision for your company or department?
*
On a scale of 1-5, with 5 being the most committed and 1 being the least, how committed are you to joining the Auni® ILIT™ Learning Network?
*
The initial investment for expert training and equipment, including an AILN-integrated ultrasound machine, is $40,000. Are you prepared to make this investment in yourself and your practice?  If you work for an institution, are you prepared to connect our team with your leadership team?
*
How do you intend to make this investment? (W-2 Income, Savings, Business Income, Other)
*
Where or from whom did you specifically hear about the Auni® ILIT™ Learning Network?
*
Submission of this form is neither formal acceptance into the Auni® ILIT™ Learning Network, nor an obligation to join. Once your application has been reviewed by a member of our team, we will be in touch with next steps.
*
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of allergyunlimited.com.

Does this form look suspicious? Report