First Name

Last Name

Email Address

Best Phone Number

How did you hear about Bowen College?

Why do you want to learn BowenFirst™? Why do you want to learn BowenFirst™? To help myself personally To help family and friends To expand my existing practice To start a practice in health care Other

Which city would you prefer? Which city would you prefer? Vancouver, BC Edmonton, BC Calgary, BC Toronto, ON

If you don't see your city, please indicate location you are interested in and/or location that best suites you. Classes are world wide so you are not limited in where you attend a workshop

Tell me about your practice. What is working in your practice?*

If you are just starting, what does your ideal practice look like?

How would you describe your business as it is right now? (The facts AND the feelings, please)*

What are you currently doing to market your practice? (If you’re doing a lot, just the highlights – positives and negatives – are fine)*

What is your #1 challenge in your business right now?*

What is your practice’s Monthly gross sales? What is your practice’s Monthly gross sales? No Sales Yet (Startup) Less than 5K per month $5,000 - $10,000 per month $10,000+

What is your current monthly marketing and advertising budget? What is your current monthly marketing and advertising budget? Less than $500 $500 - $2,500 $2,500 - $10,000 $10,000+

If we were having this discussion three years from today and you were looking back over those three years, what has to have happened in your life, both personally and professionally, for you to feel happy with your progress?

When do you want to take action? When do you want to take action? Now Soon Someday

Fill in the blank: I am ... Fill in the blank: I am ... An "Excuse Maker" who looks for opportunity but the finds "reasons" not to take advantage of them. A "Procrastinator" who wants to take action but never pulls the trigger until the opportunity is gone. An "Action Taker" who sees an opportunity and moves forward quickly.