NEMT
Full Name
Email Address
Phone Number
Business Name (if applicable)
Location (City, State)
Have you started your NEMT business yet? yesNo
Briefly describe your current business, or your vision for your future business
What are your top 1-2 goals for your NEMT business in the next 6 months?
What’s the biggest challenge you’re facing right now?
Are you ready to invest time and resources into building your NEMT business? Please explain.
What is your current monthly or startup budget?
How soon are you looking to start working with a consultant? ImmediatelyWithin 1 month1–3 months3–6 monthsNot sure
Why do you feel working with me would help you succeed?
What do you think is the #1 obstacle preventing you from taking the next step in your NEMT business?
Please confirm that you understand this is an application process, and not all applicants are accepted.I understand and agree.
What are your top 3 personal goals for the next 12 months? (These could be related to your lifestyle, family, finances, health, or anything that matters to you.)
1.
2.
3.
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