Confidential Doctor Evaluation Form

Clinic Info

About You

Do you perform:

10 - 20 min

About Your Office

PI

WC

Medicare

INS.

Cash

You think you need the most help with:

Key Questions:

Our standard: Every DC should be saving their age. If you are 40 years old you should be automatically saving $40,000 per year, or $770 per week, after tax. If you are not doing this then join immediately!

Goals

1.

2.

3.