My practice/I need(s)

Application of Acceptance

Complete each of the questions below and return this application

**(Please note ALL information is kept completely Confidential)**

Less than $100,000$100,000-$250,000$250,000-$500,000$500,000-$750,000$750,000-$1,000,00$1,000,00+

40+30-4020-3020-10less than 10

Being completely honest with yourself, do you know you are working a little harder than you would like to?




(attach additional sheet of information if necessary)

Number of hours you work, average week

No of hours you'd prefer to work, average work

% of work-time you rank as productive

No. of hours per week you work "on" vs. "in" your business

No. of Weeks of vacation taken: 2016:



No. of Weeks of vacation you'd prefer taking:

High Performance Practice Coaching Mastermind Participation Agreement Terms & Conditions

Once I am accepted into a program, I authorize to charge my card(s) as indicated in this application for membership in the Private Coaching & Mastermind Program. I understand and commit to working with total integrity, honesty and confidentiality with other members of this Special Coaching Group of like-minded top achievers. I understand and agree that, by completing and signing this enrollment form, if accepted into a program, I will have my credit card(s) charged (or check cashed) for the participation rates described on Page 4, 5 or 6 of this application based on my selected investment option for my inclusion in these private and exclusive programs.

I understand and agree that if I miss any scheduled coaching calls with that I lose that call and cannot reschedule it. I also understand that any/ all one-day consulting days, scheduled coaching calls, emergency calls and mastermind meetings expire at the end of the twelve (12) month agreement and any of the above that are unused are lost and will not carry-over past at the end of the twelve (12) month agreement and end date. Further, I agree by signing this agreement for products/ services stated herein, I am solely and completely responsible for any indebtedness incurred, as a result of my entering into this agreement with HPP. Whether I assign my rights (i.e. deciding to partner with another individual) hereunder, or delegate my obligations under this agreement, I understand that I am responsible for the complete and total amount due to HPP.

I understand and agree that by completing and signing this enrollment form that I am committing to a full twelve (12) month period in the program from the today's date as printed on page one (1) of this enrollment form. I further understand and agree that, if, for any reason, I choose to remove or cancel myself out of the program prior to the end of the twelve (12) month, program dates, I am obligated to pay or continue paying any outstanding balance(s) for the entire twelve (12) month period from the date printed on this enrollment form for any investment option I select. I understand this is a 12-month non-cancelable commitment and I understand the program details described in the letter which accompanied this agreement. Further, I fully understand and acknowledge that neither High Performance Practice, Limited Liability Company(HPP, LLC) or any representative of HPP,LLC., neither promises or guarantees any verbal or written results with relation to myself or my business and that all actions and results are up to me. I therefore hold harmless High Performance Practice, Limited Liability Company(HPP, LLC) or any representative from any / all claims that may rise from my participation in this program. High Performance Practice, Limited Liability Company(HPP, LLC) has sole discretion to terminate agreement and remove any participant from continuing in the program at any time without a refund if the participant is disrupting the program or is difficult to work with, becomes difficult to work with, or ceases to follow any of the coaching program guidelines. If done so, participant will no longer be charged the monthly rate if participant is on the monthly payment plan.

Contact Us

What do you need most to take your practice to the next level?

More New Patients

More Revenue/Profit

More Free Time

More High Value Procedures

More HR Support

All of the above