Thank you for your interest!
Upon completion of this form, you will get a "behind-the-scenes" look at what the Program is all about.
First Name*
Last Name*
Email*
Phone Number
Name of Practice(s) / Hospital System(s) you work for:*
Location (City, State)*
Have you discussed your interest in the 12w WMP with everyone on your team yet?*
Yes
No
Meeting with you (and your team) in person (or virtually) is always the most effective way at thoroughly understanding and integrating the Program. Which day(s) of the week are usually most convenient for you?
Do you have any questions I could help answer, right out of the gate?
Submit