Mentorship Application - Uprooting Lyme

Confidential Application for the 1-Year Uprooting Lyme Practitioner Mentorship Program

Practitioner's Application

Please fill out this application as thoroughly as possible. Someone will be in touch with you within 2-3 business days of receiving your application. Thanks and we look forward to connecting further!

Name: *

Best Phone Number: *

Best Email: *

Address: *

City: *

State: *

Business Name (if any):

Website (if any):

Professional License(s): *

Additional modalities you use in your practice: *

How many years have you been working with patients? *

Briefly describe your interest in becoming masterful at treating Lyme and other complex chronic diseases. *

Why is this important to you (in 1-2 sentences)? *

What are your top challenges in your practice or professional life right now? *

What is currently holding you back from solving these challenges? *

What excites you and deeply motivates you about holistic healing and/or your work with patients (in 1-2 sentences)? *

What excites you about being professionally mentored in the holistic treatment of Lyme and complex chronic diseases within an intimate group of like-minded professionals (1-2 sentences)? *

What 1-2 outcomes would you want to receive from this practitioner mentorship program? *

If applying for a partial scholarship, please explain your financial need:

What questions would you like to be sure that we cover when we speak in person?