Clinical Leadership Coaching with WCN

Clinical Leadership Coaching with WCN

Thank you for your interest in the Western Clinicians Network's Clinical Leadership Coaching Program. Our coaches are influential leaders at the intersection of the practice and the business of community healthcare. WCN Coaches are credentialed physicians, dentists, and psychologists who are providing coaching services for your professional development.

To learn more about the program, please click here.

Client Information

The client is the individual who will be receiving coaching.

Client First Name*

Client Last Name*

Client Email address*

Sponsor Information

The sponsor is the individual who is nominating the client for coaching. The sponsor may or may not be the same person signing the contract. The sponsor has the interest and authority to allow the client the adequate time and resources to participate in coaching.

Sponsor First and Last Name*

Will you be signing this contract?*

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Signatory First and Last Name*

Signatory Email*

About You

Please let us know more about you and your interest in coaching. Information you submit here will only be viewed by the WCN staff and board.

Client Organization*

Client Title/Role*

How long have you been in your position?

What do you hope to gain through coaching?*

Please provide 1 - 2 sentences on what drew you to this program and what you hope to achieve from coaching.

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