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For the Main D.C.:

(This form is for the Head D.C. only. Required for all  D.C's that have enrolled their team in the C3 Program, Connected Community or VIP 1:1 Coaching)


Completing this helps me understand you, your leadership style, and goals so I can best support your Chiropractic Assistant and your office 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.

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Question 1 of 14

Tell me about YOUR WHY, your personal Chiropractic Story - what made you want to become a Chiropractor & how long have you been one? 

Question 2 of 14

When is your Birthday:

 

 

 

Question 3 of 14

Your Favorite color:

 

Question 4 of 14

Favorite type of sweet food & any food allergies or diet restrictions (ex: Vegan, Nut allergy, Gluten free etc)? :

 

Question 5 of 14

What is your 2026 Collection Goal? Do your Chiropractic Assistants know this goal?

Question 6 of 14

What are your Monthly Goals - whether Collections, PV's, NP's etc, & does the goal change each month or stay the same? Do you Chiropractic Assistants know these goals?

Question 7 of 14

Do your Chiropractic Assistants see the office stats?

Question 8 of 14

Doesn't need to be exact but to the best of your knowledge, what has been the highest DAY of collections so far at your office? And the highest month of collections?

Question 9 of 14

Do the C.A.'s have a Bonus structure in place and if so, what is it: 

Question 10 of 14

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

Question 11 of 14

What is each Team Member already AWESOME at?

Question 12 of 14

What can each Team Member improve at?

 

Question 13 of 14

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 14 of 14

Anything else you would like to share or ask me?

 

Confirm and Submit