First Name (required)
Last Name (required)
Are you a licensed physician?---YesNo
If yes, in what state(s)?
Are you board-certified in emergency medicine? ---I am board-certified in emergency medicineI meet state-specific requirements which allow me to identify myself as board-certified (grandfathered)I have completed an emergency medicine residency programI am enrolled in an emergency medicine residency programI am not board certified in emergency medicine
How many years experience do you have as an ER physician? ---Less than 1 year1 to 3 years3 to 5 years5 to 7 years8 years or more
Address (required)
City (required)
State (required) ---ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip (required)
Company
Title
Preferred Phone (required)
Secondary Phone
Email (required)
Fax
What's the best way to schedule a call with you? Call me on my phone Call me on my mobile phone Send me a text message Send me an e-mail Some other way (Please add below)
How did you hear about the ConciER franchise opportunity? ---Saw ConciER at a conferenceHeard about it from another physicianHeard about it from a non-physicianSocial media (Facebook, Twitter, LinkedIn)Found the ConciER website via search (Google, Yahoo, Bing)
When will you be ready to invest in an ER franchise? ---ImmediatelyThis month2 to 3 months4 to 6 months7 months or more
What location would be your first choice to open a free-standing ER franchise? (City, State) ---ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
The estimated total investment to open a ConciER franchise begins at around $1.8 million (including the $60,000 franchise fee). Depending upon your market location, building site, and real estate development requirements your investment maybe be higher. How much capital do you have available to invest? ---$100,000 to $200,000$200,000 to $300,000$300,000 to $400,000$400,000 to $500,000More than $500,000
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