Scoping Call Form Page

Work Setting

Family Medicine

Urgent Care/Acute Care

Emergency Medicine

Occupational Medicine

Other

How many patients do you see on average each day?

1-5

6-10

11-15

16-20

21-25

26-30

31+

To be accepted as a private coaching client of mine, are you able to commit to attending video calls with me every 2-3 weeks?

Yes, I can commit to this schedule.

No, I don't think I would be able to commit the time.

If you were to work with me one-on-one, I will be creating a specific action plan for your practice. Can you commit to conducting these tasks in a timely manner?

Yes, I will be able to take action on tasks given to me.

No, I don't think I will be able to stick to this schedule.

Private Coaching

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