MIFAS Accelerator Application

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Let's get started... What is your name?* This field is required.
First Name
Last Name
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What is your Email?* This field is required.
example@example.com
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Mobile Phone Number?* This field is required.
Area Code
Phone Number
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What city and state are you based in?* This field is required.
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What is your practice website url?* This field is required.If you don't have one, please type "no website"
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What is your current estimated monthly revenue?* This field is required.
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What is your target monthly revenue?* This field is required.
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What do you feel is your biggest obstacle to hitting your monthly revenue goal?* This field is required.
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What insurance plans are you working with if any?* This field is required.
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How comfortable are you in MIS procedures currently?* This field is required.
I have never performed MIS procedures as of yet.
I have performed some soft tissue procedures.
I have done soft tissue and some simple exostectomy procedures.
I have performed soft tissues and MIS osteotomies but I want to improve more skills.
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How willing are you to invest in implementing MIS and growing your practice right now?* This field is required.
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2
3
4
5
Conservative
Agressive
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If we are right fit to work together, how soon would you like to get started?* This field is required.
Should be Empty: