Application to Qualify

We're going to ask some basic questions about your practice over the next few pages, many of which are simple yes/no answers. First, let's make sure we have all your contact information correct.

Next we're going to ask a little about your chiropractic background.

Tell us a little more about yourself and your training.

You're doing great! Next we're going to ask a bit about your facilities and location.

Tell us how your office and location are set up.

Next we need to see where your office is financially. Don't worry, this is only to help us understand your practice and will be kept in strictest confidence.

If you need to look up this information and come back later you can always use the "Save and Continue Later" button at the bottom of this page. If you do, we'll send you an email link you can use to pick up right where you left off when you return. This is the biggest section, but it's crucial that we know how your business is doing to best understand how to help.

This is the last full month you have information on. These numbers don't need to be to the penny, but more accurate information will help us better understand your practice.

There's just one last question about your financials.

Next, let's do a quick head count in your office.

To wrap up, we're going to ask a few final questions about your practice.

These questions help us determine if there are any areas we should help you focus on.

Hit that submit button below to package up your answers and send them off to us!