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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 10 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 19

 

BEFORE WE BEGIN...

Approach this assessment thinking about what YOU would love to get out of our time together.

 

Go beyond surface level. Be honest. Don’t give me the answer you think your doctor, your team, or even I want to hear ... tell me what’s actually true for YOU.

 

Your honest answers are here to help ME coach YOU. There are no right or wrong answers, and your answers are not being used to evaluate your job performance or determine whether you’re “good” at your role.

 

The more honest you are with me, the better I can coach and support you.

 

This is your opportunity to tell me what you already feel great at, where you’d love to grow, what you want to feel more confident doing, and what you would LOVE to see become possible for yourself.

 

Whether you’re brand new to Chiropractic or you’ve been doing this for 20+ years, there is ALWAYS another level of growth available to you.

 

I’m here to help you become more confident, connect to the power you already have, and probably show you that you’re capable of WAY more than you realize right now.

 

The more I understand YOU from the beginning, the better I can support you, challenge you, and help you grow in a way that actually matters to you.

 

So dream a little bigger than what feels realistic right now. Let me see what you really want.

 

Make sure you have 10–15 uninterrupted minutes to fully focus and complete this assessment. Your answers will NOT save if you exit before submitting, so make sure you have enough time before you begin.

 

Ready? Let’s GO. 🔥

 
 

(Select all that apply)
A

YES ... I have 10 minutes, I’m ready to be honest, and I’m excited to see what’s possible...

Question 2 of 19

Tell me a little about YOU! What is your full name, office name + location, your role/title, and how long have you been part of the team?

 

Question 3 of 19

How did you come to work at your current office? What made you want to take the position, and what were you doing before Chiropractic?

Question 4 of 19

Walk me through what YOU are responsible for in the practice. What are your main day-to-day tasks and responsibilities? ( If you are a brand new C.A. - share what the D.C. has told you abut your job duties so far)

Question 5 of 19

Tell me a few fun things about YOU ... your birthday, favorite color, favorite sweet treat (or favorite snack if sweets aren’t your thing), and any food allergies or dietary restrictions I should know about.

 

 

 

Question 6 of 19

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’ve GOT this. I know you can do it!” 😀 ... encouragement motivates me.

B

“I bet you can't get all those calls done by the end of the day..” 😏 ... said in a teasing way, challenge me and WATCH what happens.

C

Honestly, a little of BOTH. Encourage me, but challenge me too.

Question 7 of 19

How connected do you currently feel to your office goals and numbers?

(Select all that apply)
A

VERY ... I know our goals AND usually know where we are throughout the month.

B

I know our overall goals, but I don’t always know where we currently stand.

C

My D.C. has not shared goals with me yet.

Question 8 of 19

When I’m coaching you and there’s something I think you can do BETTER, how do you prefer I give you feedback?

(Select all that apply)
A

Be direct with me. Tell me what needs to change and let’s GO.

B

Encourage me first, then show me exactly what I can improve.

C

Ask me questions and help me recognize it myself.

D

I can be very hard on myself, so be very gentle with me

E

A mix ... it depends on the situation.

Question 9 of 19

When something feels uncomfortable or outside your comfort zone at work, what sounds MOST like you?

(Select all that apply)
A

I usually jump in and figure it out as I go.

B

I’ll do it, but I like to feel prepared and know what I’m going to say first.

C

I tend to overthink it a little before I take action.

D

I can get nervous about doing it wrong, so sometimes I hesitate or avoid it.

E

It really depends on the situation.

Question 10 of 19

When you’re learning something NEW, what helps you feel the most confident putting it into action?

(Select all that apply)
A

Show me exactly how to do it first, then let me try.

B

Give me the WHY behind it. Once I understand why it matters, I can run with it.

C

Let me practice it or role-play it a few times before I use it with patients.

D

Give me the basics and let me figure it out as I go.

E

A combination! I learn best with a little bit of everything.

Question 11 of 19

Which of these areas are YOU most interested in learning, strengthening, or taking to another level?

Whether you’re brand new or a seasoned C.A., just choose what stands out to YOU right now.

 

Select all that apply:

(Select all that apply)
A

Connecting and communicating with patients

B

New patient phone calls

C

Creating an amazing patient experience

D

Asking for referrals

E

Asking for reviews

F

Talking confidently about money and collections

G

Follow-up and reactivations

H

Time management and organization

I

Leadership and taking more ownership

J

Building my overall confidence

K

Something else not listed here

Question 12 of 19

When you think about your role right now, what do you feel MOST confident doing?

 

What comes naturally to you or makes you think, “Yep ... I’m GOOD at this”?

Question 13 of 19

Now the opposite ... what parts of your role do you feel LEAST confident doing right now?

 

What conversations, tasks, or situations make you hesitate, overthink, avoid, or feel uncomfortable?

Question 14 of 19

Is there anything happening inside the office right now that feels challenging, frustrating, or is making it harder for YOU to thrive in your role?

This could be something with your doctor, another team member, communication, your workload, the office environment, or anything else you feel is important for me to understand.

You can be completely honest here. Share only what you feel comfortable sharing.

 

Don’t think about what your doctor or anyone else wants for you here ... what would make YOU proud of your own growth?

Question 15 of 19

What is the BIGGEST goal you have for yourself through our coaching together INSIDE the office?

What would you LOVE to become more confident doing, strengthen, or see change for yourself at work?

 

And if there are any frustrations, challenges, or situations happening at work that you think would help me understand you better, you can share those too.

Question 16 of 19

What is the biggest goal or target you have for YOURSELF outside of the office?

 

Think personal here ... what are you working toward, dreaming about, or wanting to create in your own life?

Question 17 of 19

Do you have a 2026 Goal Board or Word of the year?

A

I have both of those

B

I have one of those

C

I've done either a goal board or Word of the year in the past but not currently

D

I've never done either of those yet

Question 18 of 19

Share a time you remember having FUN at the office with another team member OR a moment with a patient that still brings a smile to your face.

 

What happened? (If new, share a moment from a previous job)

 

Question 19 of 19

Is there anything else you want me to know about YOU before we get started? Something you want to share, something you want to ask me, or something you think would help me coach you better?

Confirm and Submit