Mentorship Program Application

This is a survey as part of the Mentorship Program application in order to best match up Mentors with Mentees

Fields marked with an * are required.

Please verify that you have checked the “I'm not a robot” checkbox.

Mentor
Mentee

Adjusting & some supportive therapies
Adjusting only
Physical therapies
Rehab Therapies
Sports (Performance) Medicine
Pediatrics
Acupuncture
Nutrition
Functional Medicine
Other

Active Release Technique (ART)
Acupuncture
Applied Kinesiology
Atlas Orthogonists
B.E.S.T.
Bioenergetics
Brimhall
CBP
Cold Laser
Cranial Sacral
Decompression
Diversified
DNFT
Drop Techniques - Thompson
Drop Techniques - Other
Dry Needling
Extremity Adjusting
FAKTR-PM
Flexion-Distraction - Cox
Flexion-Distraction - Leander
Full Spine
Gonstead
Graston
Instrument Adjusting - Activator
Instrument Adjusting - Atlas Orthoganal
Instrument Adjusting - Impulse
Instrument Adjusting - Pro-Adjuster/Sigma
Instrument Adjusting - Torque Release
Instrument Adjusting - Other
Integrative
Kinesiotaping
Logan Basic
Low/Non Force Techniques
Motion Palpation
Myofascial Release
NET
Nimmo
Palmer Package
Pettibon
Sacro Occipital Technique (SOT)
Soft Tissue
Upper Cervical - NUCCA
Upper Cervical - Toggle
Upper Cervical - Other
Webster

None; cash only
Medicare - Participating
Medicare - Non par
Aetna
Anthem BC/BS (PPO)
Carefirst BC/BS
Cigna
ASHN
Optum/United Healthcare
Other

Yes
No

This is to determine whether you'd prefer a mentor/mentee closer to where you practice, or in a different area of the state entirely.