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Personal Information
Full Name
(Required)
Email Address
(Required)
Phone Number
(Required)
Practice Name
(Required)
Practice Location
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Professional Background
Years in Practice
Less than 1 year
1-3 years
4-6 years
7+ years
Practice Type
Small Animal Practice
Equine Practice
Mixed Animal Practice
Mobile Veterinary Service
Specialty/Referral Practice
Other (Please Specify)
Current Practice Size
Solo Practitioner
2-5 Doctors
6-10 Doctors
10+ Doctors
Your Business & Leadership Goals
What are the biggest challenges you face in your practice?
(Required)
What specific goals do you want to achieve in the next 90 days?
(Required)
Have you attended any previous Vetripreneur events, bootcamps, or worked with Dr. Jeff Munn?
Yes
No
If Yes, specify which program
Program Commitment & Readiness
Why do you want to join the Vetripreneur Council?
The Vetripreneur Council requires a high level of participation, including twice-weekly coaching sessions and hands-on implementation. Are you ready to commit to this level of engagement?
Yes
No
Can you dedicate time for two 90-minute coaching sessions per week and execute growth strategies between sessions?
Yes
No
Preferred Session Time (Select All That Apply)
Morning Sessions (9 AM – 12 PM EST)
Afternoon Sessions (12 PM – 5 PM EST)
Evening Sessions (5 PM – 8 PM EST)
Final Steps
How did you hear about Vetripreneur?
Social Media
Referral
CE Event
Email
Other
I understand that this is a structured program requiring active participation and that acceptance is based on availability and qualifications.
Yes, I agree