Home
Referral Program
Start Application
Solution Activation Session
Call Now

Assessment:

Consideration For Acceptance To Our Program

Please answer the questions below. We're not looking for long essays, rather, short succinct answers to help us know if you'd be a good fit for our program.

Business Name *

Business Website *

How long have you been in business? *

Less than 1 year

1 to 2 years

2-5 years

More than 5 years

Which ownership scenario best describes you? *

I’m the owner and sole decision maker and don’t need input from anyone else

I have a partnership, we make choices together

I’m the GM/Sales Manager

I'm a franchisee or franchisor with one or more locations

What is your monthly advertising budget? *

Less than $500

$501-$1000

$1001-$1999

2000-4999

$5000+

How many contacts to you have access to including current patients, past patients, or any leads you have generated? *

Less than 500

500-999

1000-1999

2000-4999

5000+

How willing and able are you to invest in the growth of your business right now? *

I have the financial resources to invest in my business right now

I have access to the financial resources to invest in the growth of my business right now

I don't have any financial resources to invest in the growth of my business

What has been your biggest challenge(s) in reaching your maximum financial potential? *

Finally, what makes you different from the other applicants in your local area, and why should we choose to work with you? *

First Name *

Last Name *

Email *

Cell Phone *

20 Patients In 10-Days… GUARANTEED!

& if we dont - We'll pay YOU!

100% Zero-Risk System.

This website is not a part of the Facebook website or Facebook Inc.

Assessment:

Consideration For Acceptance To Our Program

Please answer the questions below. We're not looking for long essays, rather, short succinct answers to help us know if you'd be a good fit for our program.

20 Patients In 10-Days… GUARANTEED!

& if we dont - We'll pay YOU!

100% Zero-Risk System.

Chiro Patient Accelerator 2021. All Rights Reserved.

Additionally, this website is NOT endorsed by Facebook in any way. Facebook is a trademark of Facebook, Inc.

Home |Privacy Policy | Terms | Cancellation Policy