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Jena's 1-on-1 Consultation Application
Please answer all questions as specifically and thoroughly as you can.
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Name
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First
Last
Email
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Phone Number
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Skype ID
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How did you hear about The Independent Clinician?
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Where are you in the process of developing your private practice?
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Please be as specific as possible.
Describe your dream private practice. What are you hoping to achieve?
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Tell me about yourself: What is your background? Area of expertise? Geographic location?
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How can I help you?
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Complete this sentence: The consultation sessions will be a success if I am able to __________________.
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I understand that the fee for the consultation is $150 for two, 30 minute sessions.
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Yes
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Resources
FREE Beginner Training
START Your Practice
GROW Your Practice
Clinic Forms
Free Course
Join The Community
Podcast
Login