🏝️ SHIFT Core Community Intake Form: Your Freedom to SHIFT Permission Slip

You're here because you’re ready to make an impact and income with skills you have AND without burning out.

Whether you're leaning toward coaching, consulting, telemedicine, or a mix, this form helps us build your custom Freedom to SHIFT plan.

Email *

Legal First Name *

Legal Last Name *

Mobile Number (will NOT be shared with third parties and will only be used for internal service purposes) *

Instagram Handle *

Address *

Street Address

City

State

Country

Postal code

Shirt Size *

By checking this box, I agree to use electronic records and signatures and I acknowledge that I have read the terms.

Clinical and Professional Background

Professional Background *

MD/DO

NP/PA

Other

If you chose other, what is your profession? Or do you have any additional info to add regarding your education (ie, I'm a resident) *

What is your medical specialty or field of interest? *

Are you still working in person? *

Part Time

Full Time

Not working at all clinically

What’s Your Freedom Vision?

Which of these interest you? (select all that apply) *

Do you want to include telemedicine in your offer? *

Yes - 100%

Maybe - I want to explore it

No - I want to focus on coaching or consulting

Clarity on Direction

What’s your #1 goal for building a remote offer? *

What would a $10K/month business buy you: time, freedom, what else? *

What do you feel most confident teaching, guiding, or helping others with? What can't you stop talking about at dinner when everyone's eyes glaze over? *

Experience and Assets

Have you ever coached or consulted before? *

Yes, Paid

Yes, Unpaid

I didn't realize people asking me for advice for free was consulting!

Not yet

Do you have any of the following set up already?

Time to get real.

What’s stopping you from launching now? (choose all that apply) *

If you chose Any other reason, please explain:

What would make this community wildly valuable to you? *

Thank you for taking the time to dive in with me!

Don't forget to hit SUBMIT below and click HERE to embed our coaching calls into your calendar.

I'll review your answers and reply by email shortly. 🚀