LIVE Coaching Course Pre-Arrival Form

Hi! I'm looking forward to meeting you! Before we meet, I'd like to get some additional information from you so that I can help you to the best of my ability. Please fill out the form below. Fill out ALL of the fields that are applicable to you. If something doesn't seem applicable, simply type N/A in the field and explain why it doesn't apply to you.

LIVE Coaching Pre-Arrival Form - Questionnaire

  • In case we need to mail something to you for the course, what is the best mailing address. Keep in mind that it may arrive very close to the date of the course.
  • Hidden
    Required if this course is an in-person live course. Not required if this is an online live course.
  • Hidden
    Please assume that you'll need to leave at about 2.5 hours prior to your flight if you have a car to return. This may help us determine the order in which to have the one-on-one sessions. Required if this course is an in-person live course. Not required if this is an online live course.
  • Hidden
    Required if this course is an in-person live course. Not required if this is an online live course.
  • If you are still in residency, please write your current PGY level.
  • If this is your first time, write "This is my first time."
  • If this is your first time, write "Never taken."
  • For the ABP initial certification exam, passing is 180. If possible, please list ALL of your previous years and scores. If you are listing a different exam, please also list the passing score next to it in parenthesis.
  • MM slash DD slash YYYY
  • If you're NOT a member, please type "I'm not a member" and briefly explain why you decided not to get this recommended resource.

Ashish Goyal, M.D.