Join A Focus Group!
Apply now for a Focus Group (AKA Mastermind Group)
Name *
Email Address *
Cell Number *
Your Website or Facebook Page
Where are you in your private practice journey? (check all that apply)
Are you in a solo or group practice?
Clear selection
How long have you been in practice?
Current average monthly practice income?
What is your goal income; where would you like to be?
What is unique about your practice or niche?
Why are you interested in joining a Focus Group?
What would you like the most help with? What are your goals for being in the Focus Group?
What do you see as the current barriers for you in reaching your goals? (be honest)
What are your business goals?
Who referred you to me and how did you learn about The Practice of Therapy?
What questions do YOU have?
I understand that by joining the focus group I am committing to regular attendance, confidentiality about what is discussed, and participation outside the group meetings. I also understand the financial commitment and agree to the terms of this agreement. *
Never submit passwords through Google Forms.
This form was created inside of Kingsport Counseling Associates, PLLC. Report Abuse