First Name *

Last Name *

Phone *

Email *

Website

1. What best describes your current practice structure? *

Single location

Multi-location (3–5 locations)

DSO or emerging group practice

Other

1.1 If Other describe your practice structure

2. What are your top 1–2 goals you want to achieve in the next 6–12 months? *

3. What are the biggest obstacles currently preventing you from reaching those goals? *

4. What have you already tried to address these challenges? *

5. Are you currently working with any outside consultants, coaches, or marketing partners? If yes, what’s working and what isn’t? *

6. How ready are you to move forward with support if we’re the right fit? *

I’m just gathering information

I’m actively evaluating support options now

I’m ready to move forward if it’s a good fit

I’ll need internal or partner approval

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