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DR. CHARLES WARD'S INNATE LEGACY 4301 WEST WILLIAM CANNON AUSTIN, TEXAS 78749 (925) 855-1635 OFFICE PHONE (925) 855-1637 OFFICE FAX info@innatelegacy.com EMAIL JOIN DR. CHARLES WARD ON FACEBOOK JOIN OUR MAILING LIST BY EMAILING US If you are interested in more information about becoming a member of WSS, please fill out the following form and we will get back to you soon to schedule a phone consultation with Dr. Ward.
DR. CHARLES WARD'S INNATE LEGACY
4301 WEST WILLIAM CANNON AUSTIN, TEXAS 78749
(925) 855-1635 OFFICE PHONE (925) 855-1637 OFFICE FAX info@innatelegacy.com EMAIL
JOIN DR. CHARLES WARD ON FACEBOOK
JOIN OUR MAILING LIST BY EMAILING US
NAME: * OFFICE PHONE: * CELL PHONE: FAX: EMAIL ADDRESS: ADDRESS CITY/PROV. STATE ZIP/PC BEST TIME OF DAY TO CALL: TOTAL YEARS IN PRACTICE: TOTAL YEARS AT CURRENT LOCATION: WHO REFERRED YOU TO WSS? WHAT WOULD YOU LIKE TO ACHIEVE IN YOUR PRACTICE IN THE NEXT YEAR? WHAT ARE THE CURRENT CHALLENGES HOLDING YOU BACK FROM PRACTICE GROWTH? WHAT QUALITES ARE YOU LOOKING FOR IN A COACHING PROGRAM? CURRENT MONTHLY AVERAGES NEW PATIENTS PATIENT VISITS SERVICES COLLECTIONS PLEASE RANK IN ORDER OF IMPORTANCE TO YOU. (1 = most / 4 = least ) Profit Growth Time Peace of Mind HAVE YOU EVER WORKED WITH OTHER CONSULTANTS/COACHES? IF YES, WHO/WHEN * Indicates Required Fields
NAME: *
ADDRESS
ZIP/PC
BEST TIME OF DAY TO CALL:
TOTAL YEARS IN PRACTICE:
TOTAL YEARS AT CURRENT LOCATION:
WHO REFERRED YOU TO WSS?
WHAT WOULD YOU LIKE TO ACHIEVE IN YOUR PRACTICE IN THE NEXT YEAR?
WHAT ARE THE CURRENT CHALLENGES HOLDING YOU BACK FROM PRACTICE GROWTH?
WHAT QUALITES ARE YOU LOOKING FOR IN A COACHING PROGRAM?
CURRENT MONTHLY AVERAGES
PLEASE RANK IN ORDER OF IMPORTANCE TO YOU. (1 = most / 4 = least )
HAVE YOU EVER WORKED WITH OTHER CONSULTANTS/COACHES? IF YES, WHO/WHEN