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C.A. & Staff Members:

(Required for all  C.A.'s in the C3 Program, Connected Community or VIP 1:1 Coaching)

Each Chiropractic Assistant &  Team Member must individually Complete this form. If you are the Main D.C., fill out the Main D.C. form to the right instead. 

This quick online form collects general details + goals form you so I can better support your team’s systems, communication & growth.

📌Fill out when you have at least  5 Minutes to truly focus because this MUST be completed in one sitting & does not save your information until you submit.

Click below to begin.

Start

Question 1 of 11

Type below your Full Name first & last name) , Role/Title at your office & how long you have worked there?

 

Question 2 of 11

What made you apply for the office ( or how did you come to work there) and tell me about what your did prior?

Question 3 of 11

List some of your day to day tasks:

Question 4 of 11

Do you have weekly team meetings and if so what day/time?

Question 5 of 11

List Your Birthday, favorite color, favorite type of sweet dessert (or alternatives if you are not a sweets person) and any food allergies or diet such as Vegan or Gluten free:

 

 

 

Question 6 of 11

If I were to give you a task, which phase below would encourage you more and make you want to get it done?

A

You can do it! (in an encouraging way)

B

You can't do it! (in a teasing way)

Question 7 of 11

How aware are you of the office collection numbers and any goals, whether they're monthly or yearly collection goals that your doctor has. Do they share these numbers with you?

Question 8 of 11

What is the biggest goal/target you have from us training together INside the office? As in, what changes would you like to see happen with your team & you get better at? Any frustrations with your team or work? This is a safe place to say anything that is only between us. You can say as little or as much as you would like:

Question 9 of 11

What is the biggest goal/target you have for yourself OUTside of the office? Think personal goals:

Question 10 of 11

Share a time you remember having FUN at the office esp with another team member OR a moment that stood out with a patient, something that brings a smile to your face?

 

Question 11 of 11

Anything else you would like to share or ask me?

 

Confirm and Submit