TJ Ahn Consulting Application (TJ)

1

Let's get started... What is your name?* This field is required.

First Name

Last Name

2

What is your Email?* This field is required.

example@example.com

3

Mobile Phone Number?* This field is required.

Area Code

Phone Number

4

What City, Country do you practice in?* This field is required.

5

What is your practice website url?* This field is required.If you don't have one, please type "no website"

6

What is your current estimated monthly revenue?* This field is required.

7

What is your target monthly revenue?* This field is required.

8

Are you currently working with any marketing agency to generate patient leads?* This field is required.

Yes

No

9

What do you feel is your biggest obstacle to hitting your monthly revenue goal?* This field is required.

10

What insurance plans are you working with if any?* This field is required.

11

How willing are you to invest in the growth of your practice right now?* This field is required.

12

Which consulting program(s) are you interested in?You can choose one or more.

The MIFAS Accelerator - Implement MIS procedure and Office-Based Surgery

The Profit Alchemy - Increase Cash Pay and Patient Acceptance

The Podiatry Profits Mastermind

13

If we are right fit to work together, how soon would you like to get started?* This field is required.