Suite or Office No.
City, State and Zip
Evaluating Your Existing Practice
1. Do you feel that you are known as a pediatric or family wellness chiropractor? Yes
2. Do you want to expand in the area of chiropractic pediatrics or family wellness? Yes
3. My commitment to children and Chiropractic Pediatrics is…
4. Please check where you and your office are in regards to a Family Wellness Practice.
Needs Major Work
In Office Events/Programs
School Outreach Programs
New Patient Protocol
5. Would you like me to follow up with you on how we can develop your family wellness practice? Yes
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