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Are you working with a franchise consultant?
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Please Select
Yes
No
Prefix
Please Select
Mr.
Mrs.
Ms.
First name
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Last name
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Email
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Cell phone number
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Country
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Please Select
United States
Other
Preferred city(s)/Metro area(s)
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What specific type of opportunity are you interested in?
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Please Select
Add 10X Health to my existing medical practice
I would like to open a new 10X Health unit franchise
Are you a US citizen?
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Yes
No
What is your highest level of education?
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Please Select
High School
Some College
University/College
Graduate Studies
Other
When would you like to start the business?
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Immediately
1-3 months
4-6 months
7+ months
How much in available liquid funds do you have to invest into your business?
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<$100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 - $300,000
$300,000 - $400,000
$400,000 - $500,000
>$500,000
Do you currently own a business? If yes, please provide the business name.
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What is the annual revenue of your current business?
Do you currently have recurring monthly income?
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Yes
No
What is your estimated net worth?
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Are you a licensed medical professional? (choose all that apply)
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No
MD
DO
NP
PA
RN
DDS
Other
Do you currently own a Medical Practice?
Yes
No
Will you require assistance to source financing options?
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Yes
No
How is your credit?
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Excellent
Good
Fair
Poor
Are there any issues or obstacles that need to be addressed prior to you getting started?
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Yes
No
Are you looking to replace or enhance your current income?
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Replace
Enhance
Create transition income
Not sure
Present / Most Recent Position
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Annual Earnings
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Previous Position
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Do you currently or have you ever owned a business?
Yes
No
Have you managed employees?
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Yes
No
Are you planning to be hands-on or a passive owner?
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Hands-On
Semi-Passive
Completely Passive
Do you plan to operate the business yourself?
Yes
No
With family
With partner(s)
What is your motivation for looking into a new franchise / business opportunity?
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Security/Family Time/Tired of Corporate Grind/Flexibility/etc.
Have you ever considered starting your own business form scratch or have you decided you are more interesting in working within a franchise system?
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Do you tend to be assertive or non-assertive in your undertakings?
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Assertive
Non-Assertive
Would you characterize yourself as being extroverted or introverted?
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Extroverted
Introverted
Are you task oriented or people oriented?
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Task
People
Both
How are your internet marketing skills?
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(Adwords, PPC, SEM, etc.)
Strong
Knowledgeable
Little
None
How are your social media skills?
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(Facebook, Instagram, LinkedIn, TikTok, etc.)
Strong
Knowledgeable
Little
None
How long have you been looking into purchasing a business / franchise opportunity?
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Just started
1-3 months
3-6 months
6+ months
Have you worked with any business or franchise brokers? If so, please share their name(s) or company.
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Are you presently looking into any other business or franchise opportunities?
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Have you ever reviewed any Franchise Disclosure Documents (FDD's) for any other brands? If so, which ones?
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Customer Declaration
I hereby confirm that all the information provided are true and correct.
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Submit