Quick qualification

Tell us who you are.

Start with the basics. You can save and continue later.

First name

Last name

Email

Phone

City / State / Country

Current practice type

Practice name

How many surgeons are in your practice?

What is the biggest challenge in your career or practice right now?

Why are you interested in The Aligned Surgeon?

Section 2 · You

Your current reality.

What originally made you want to become a plastic surgeon?

What part of practicing medicine currently gives you the most energy?

What part drains you?

What are you most proud of professionally?

What do you think you are capable of that you have not yet built?

What does success mean to you right now?

What would success mean three years from now?

Section 3 · Craft + practice

What are you building clinically?

What procedures comprise most of your current practice?

What procedures do you enjoy most?

What are you currently best known for?

What would you like to become known for?

Where do you believe your clinical work is differentiated?

Have you developed or modified techniques, published, taught, researched, or lectured?

Section 4 · Business + team

How does the practice operate?

Annual practice revenue range

Team size

Operating days per month

Consult conversion % if known

Do you own or participate in an ASC, med spa, or real estate?

Describe your current culture in five words.

If you disappeared for 30 days, what would stop functioning?

What decisions still require you personally?

Section 5 · Brand + life

What should your success create?

Why should a patient choose you instead of another qualified surgeon?

What do you think patients currently associate with your name?

What does your current week look like?

What does your ideal week look like?

What are you unwilling to sacrifice for business success?

If everything went right over the next three years, describe your life in detail.

Final section

Why now?

The purpose of this application is fit—not perfection.

Why now?

Why do you believe Jerry is the right person to help you?

Anything else we should know?

Please do not include patient-identifiable information or protected health information in this application or any program upload.