Sapphire Program Application

33%

Today's Date*
Name*
FirstLast
Email*
Website
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone*
Assistant Name
FirstLast
Assistant Email
Assistant Phone
Fax

Please, Tell Us About You
Have you worked with Casey previously?*
- Yes
- No
Are you currently in private practice? If so, for how long? How many sessions do you average per week?*
What is the vision for your business for the next year? What would be ideal?*
Are you interested in adding business models other than one-to-one private practice? if so, what do you envision?*
What do you believe has stopped you from reaching your current goals? (The coach in me wants you to give this question serious thought as it has the opportunity to create a breakthrough and potentially exponentiate our work together.)*
What is the most challenging aspect of growing your business? *

Let’s look at the numbers:
If you are in the US, what percentage of your income comes from managed care?
What is your income before expenses so far this year? *
What was your income last year?*
Where would you like your business to be in 5 years?*
Is your practice your only form of income?*
- Yes
- No
If not, where else does your income come from?
What level of debt are you currently carrying? Will investing at this level in your program put you in financial distress?*
What else would you like Casey to know that may not have been asked?
All information is 100% confidential. The 2012 More Clients for Me Mentorship Program is a non-refundable commitment. In the case of cancellation due to extreme circumstances, cancellation will be processed through an application letter and exit interview with Casey.

Comments on this entry are closed.

Please, Tell Us About You