Mentorship Application

This is an application for MENTORSHIP, COACHING, and PROGRAMS with Michale Chatham and Airway Intelligence Institute.

Based on your answers I will offer you an exploratory call with me.

Click the button below to start.

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Question 1 of 16

What is your Name with Credentials?

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Question 2 of 16

Email Address

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Question 3 of 16

What is the name of your practice/business?

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Question 4 of 16

What type of Mentorship are you interested in?

(Select all that apply)

A

Clinical Mentorship

B

Business Mentorship

C

Both

Question 5 of 16

What is your Outcome? What is it that you want?

Be Specific. It can be; more money, clients, better sex in my relationship or just to work less and earn more, to navigate my awakening, etc. No rules. No judgement.

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Question 6 of 16

What is your greatest fear?

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Question 7 of 16

What are your immediate needs in your practice?

Choose as many as you like.

(Select all that apply)

A

Make more money

B

Recover from or prevent Burnout

C

Staff Training, Cohesion and Team Building

D

Better Outcomes with Clients

E

Marketing / More clients and patients

F

I don't know what I want / need, I only know something needs to change

G

I am having a spiritual awakening and am not sure what to do with it

H

Other

Question 8 of 16

Where do you live?

Country/Time Zone

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Question 9 of 16

What type of practice do you have? What type of practice do you dream of?

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Question 10 of 16

What Licenses or Certifications do you use in your practice?

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Question 11 of 16

What Continuing Education have you taken? Most recently. What was good about it, not helpful about it?

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Question 12 of 16

Have you ever been Mentored or Coached before?

A

Yes

B

No

Question 13 of 16

If you have been Mentored or Coached, by whom?

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Question 14 of 16

What is your Timeline for Results?

A

I needed results yesterday

B

3 Months

C

6 Months

D

Within the year

Question 15 of 16

Are you in a position to make a financial investment in what you want?

A

Yes

B

No

Question 16 of 16

Why are you a candidate for an exploratory call with me?

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Confirm and Submit

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Email

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Mentorship Application

Click the button below to start.

What is your Name with Credentials?

Email Address

What is the name of your practice/business?

What type of Mentorship are you interested in?

What is your Outcome? What is it that you want? Be Specific. It can be; more money, clients, better sex in my relationship or just to work less and earn more, to navigate my awakening, etc. No rules. No judgement.

What is your greatest fear?

What are your immediate needs in your practice? Choose as many as you like.

Where do you live? Country/Time Zone

What type of practice do you have? What type of practice do you dream of?

What Licenses or Certifications do you use in your practice?

What Continuing Education have you taken? Most recently. What was good about it, not helpful about it?

Have you ever been Mentored or Coached before?

If you have been Mentored or Coached, by whom?

What is your Timeline for Results?

Are you in a position to make a financial investment in what you want?

Why are you a candidate for an exploratory call with me?

Confirm and Submit

What is your Outcome? What is it that you want?

Be Specific. It can be; more money, clients, better sex in my relationship or just to work less and earn more, to navigate my awakening, etc. No rules. No judgement.

What are your immediate needs in your practice?

Choose as many as you like.

Where do you live?

Country/Time Zone