DGDC Guest App (YTP)

1
2
Which of these best describes your brick and mortar (physical) practice right now?* This field is required.
Brick and Mortar is Still Growing
Brick and Mortar is at +90% Capacity
I don't have a Brick and Mortar
3
Which of these best describes your online (virtual/telehealth) practice right now?* This field is required.
My Online Practice is Still Growing
My online practice is humming along (+100k/year)
I'm not practicing online (yet!)
4
Your Name* This field is required.
First Name
Last Name
5
What is your Mobile Phone Number?* This field is required.This is very important so that we can recognize you in our DGDC group chat. We respect your privacy and do not call you, text you, or bother you in any capacity.
example: 555 - 698- 5575, or +61 555 555 555, etc
6
Where can we find out more about your work?* This field is required.What's the URL for your Website, Facebook, Instagram, TikTok, Any Groups You Run, etc?
Huge
Large
Normal
Small
Ok
Ok
7
Email* This field is required.So that we can send you 1 email to let you know if your application is successful.
example@example.com
8
How did you find your way to the DGDC?* This field is required.Who referred or invited you?
9
Do you have any specialties? What are your favorite types of cases to treat and people to work with?* This field is required.Please be as detailed and specific as possible
Huge
Large
Normal
Small
Ok
Ok
10
What's your "why"? What motivated you to decide to go into this career?Please be as detailed and specific as possible
Huge
Large
Normal
Small
Ok
Ok
11
How Long Have You Been in Practice?* This field is required.
0-2 Years
3-5 Years
5-10 Years
10-20 Years
20+ Years
I'm currently a student
12
On average, how many hours per week do you work?* This field is required.
0-10
10-20
20-30
30-40
40-50
50+
13
What is your average gross monthly revenue?* This field is required.Gross revenue is the total money collected (not including expenses)
$0 - $10k USD
$10k - $20k USD
$20k - $50k USD
$50k+
14
What are your specific goals one year from now?* This field is required.Where would you like to see yourself, both personally and professionally?
Huge
Large
Normal
Small
Ok
Ok
15
What are the biggest challenges/obstacles for you right now in reaching those goals?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
16
What are some of the frustrations or areas for improvement within your practice?* This field is required.Patients not completing treatment plans, no shows, cash flow, hiring etc
Huge
Large
Normal
Small
Ok
Ok
17
What are some of your favorite books and movies?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
18
What are some of your favorite movies?
Huge
Large
Normal
Small
Ok
Ok
19
Please list the most significant courses, trainings, mentorships, programs you've done in the past. What did you love about them? And where did they fall short?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
20
What is your relationship to burnout?* This field is required.(choose as many as apply to you)
I've experienced burnout in the past, but pretty well over it now
I've never experienced burnout, but would like to plan to avoid it if possible
I might be experiencing burnout right now
I'm definitely in the middle of burnout right now. It sucks.
I'm currently working my way out of burnout
I'm confused- wtf is burnout?
21
Do you consider yourself to be a decisive person?* This field is required.(decisive = you make decisions quickly and easily)
Yes!
Hmmm, I'm not sure.... I'd have to think about that...
22
Is there anything else we should know about your specific situation or what you're looking to learn here?* This field is required.Please be as detailed and specific as possible
Huge
Large
Normal
Small
Ok
Ok
23
Is there anything that you believe to be true that is controversial or others may disagree with you about?
Huge
Large
Normal
Small
Ok
Ok
24
Lastly, what is a piece of wisdom or advice you would pass on to someone just starting out in your field?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
25
Do you agree to respect our Group Rules?* This field is required.(They're straightforward and can be read within our Insights Vault check-in area)
Yes!
26
Do you agree to respect our group?
27
By signing below I agree to follow the group rules, and to complete my check in process within 72 hours once I've arrived. My answers on this form are accurate, true and honest; this form is complete and ready to be submitted to Jeremy.
Clear
Should be Empty: