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Open Access Application
Name
*
First
Last
Preferred Email
*
Telephone Number
*
What are your credentials? (MD, ND, DC, NP, PA, etc.)
*
Copy of qualifications/certifications/licenses (or if a student, copy of transcripts/course outline and proof of enrollment)
*
*If credentials are in a language other than English, please provide a certified English translation.
Please select which you would like to apply for:
*
Open Access - $1,400 for 3 months + $400 monthly after
Open Access Teach-Ins - $275 for 3 months + $35 monthly after
I would like to participate in a Focus Group with the Clinic Immersion Team to discuss practitioner mentorship and professional development needs.
Yes
No
Where Did You Hear About us?
Dr. Kara Email
Social Media
3rd Party Email
3rd Party Social Media
Colleague or Friend
Other
If "Other" Tell Us More.
Additional Comments?
Please allow up to 10 business days for your application to be processed. Once it has been reviewed, you will receive an email with next steps.
