DC Quick Eval Form

Clinic Info

First Name:

Last Name:

Email Address:

Phone Number:

Street Address 1:

City:

Country:

State/Province:

Zip/Postal Code:

How Did You Hear About Us?:

About You

About Your Office

How many visits a week are you seeing on average?
0 - 50 50 - 100 100 - 150 150 - 200 200 - 250 250 - 300 300 - 400 400+

How many visits do you want to see per week?
0 - 50 50 - 100 100 - 150 150 - 200 200 - 250 250 - 300 300 - 400 400+

How much are you collecting per month?
$0 - $10,000 $10,000 - $20,000 $20,000 - $30,000 $30,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000+

How much do you want to collect per month?
$0 - $10,000 $10,000 - $20,000 $20,000 - $30,000 $30,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000+

You think you need the most help with

Key Questions

Find out if you have what it takes to be a WINNERSEDGE Member!

Are you serious about hiring a practice success consultant?
Do you want to learn how to be a more successful chiropractor?
Are you willing to put in the hard work required?

The typical WINNERSEDGE DC grows 50 to 200 visits per week and collects $50,000 to $250,000 more their first year!

One call with us can change your life!

DC Quick Eval Form

Our Standard:

Find out if you have what it takes to be a WINNERSEDGE Member!