CEO of You Enrollment CEO of You Integrative Coaching Enrollment Today's Date(Required) MM slash DD slash YYYY Name(Required) First Last Email(Required) Practice Name(Required) Practice Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many years have you been in practice?(Required) What is your annual gross revenue range for your practice?(Required) Under $250,000 $250,000 – $500,00 $500,000 – $750,000 $750,000 – $1,000,000 over $1,000,000 How many employees do you have?(Required)Do you have any sub-specialties in your practice?(Required)Please select all that applies from the option below. Only Primary CareDry Eye Disease ManagementMyopia ManagementOcular AestheticsVision TherapyNeuro-OptometryIntegrative OptometryDigital Eye HealthMedical OptometryOther Specialty Not Listed Above What do you think is your greatest challenge in your business?(Required) Where do you see your practice in 1 year from now?(Required) Where do you see your practice in 15 years from now?(Required) Consent(Required) I agree to the CEO of You Coaching PolicyCOMMITMENT: • The Coach/consultant and client commit to working with each other for an initial twelve month period. This allows the necessary time to assess the needs of client, develop goals and a strategic plan to achieve these goals. • The consulting program will automatically renew each year unless client cancels. The client and/or coach may cancel program at anytime with 30 days written notice. Cancellations will take effect within 30 days of receiving written notification. • There are no refunds of payments made. However, subscriptions can be cancelled at any time after 30-days’ notice. SESSION PROCEDURES: • Client will receive a 1-hour coaching session per month depending on payment package selected. • At the scheduled appointment time, the Client agrees to join their coach via video conference at the provided platform. • If the client is more than 15 minutes late for a coaching session, the Coach will assume the session is cancelled and the client will forfeit the session. CONFIDENTIALITY • The Coach and client agree to keep all conversations and information discussed during the program private and confidential. • In the event of any disgruntlement, the coach and client agree not to clobber each other on any media on-line and off-line. • Sessions may not be recorded without the written consent of both parties. ACCEPTANCE • Entering this program is entirely based on this covenant – that you have acknowledged that you accept 100% responsibility for your actions (or lack of actions), your success, and your decisions. • Your consent indicates your acceptance of the responsibilities outlined herein and your release of all individuals and companies related to this program from any legal responsibility for your decisions in the program.
