Healing Wave Chiropractic Associate Questionnaire
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Contact Details
Full Name
Address
Nationality
Mobile Number
Email Address
Qualifications
Pre-Chiropractic Qualifications
Year Graduated:
Clinical Chiropractic Experience
Chiropractic Details
What is your vision of Chiropractic?
Describe your ideal practice (ideal volume, preferred hours and days, etc.)
Are you willing to learn and be coached?
Are you willing to attend seminars?
What are your preferred Chiropractic techniques?
What X-Ray analysis do you use?

Please describe your new patient procedure on a forty (40) year old patient with  

chronic low back complaint (no major pathology, slight degenerative changes in the  lower lumbars and a reversed cervical curve). Please indicate number of visits, re exam etc.

How often do you get yourself checked and what do you have a preferred technique?
Practice Goals
What are your practice goals?
Immediately
Six Months
One Year
Two Years
Five Years
How do you feel about a two (2) year contract as an Associate?
What is your preferred remuneration formula and how much do you want to earn?
What do you hope to gain by becoming an Associate in one or our clinics?
Ideal Life
Describe your ideal life: What are the most important things in your life? List five in order of priority
1
2
3
4
5

What are your life goals? 

Immediately
Six Months
One Year
Two Years
Five Years
What do you perceive to be your known strengths?
What do you perceive to be your known weaknesses?
What other information do you feel might be important in helping us to understand  you?
Do you have any questions in return?
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