Step 2: Please Complete Your Remaining Details. First Name * Last Name * Email * Company Job Title City * Country * Please select one Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas (the) Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory (the) Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands (the) Central African Republic (the) Chad Chile China Christmas Island Cocos (Keeling) Islands (the) Colombia Comoros (the) Congo (the Democratic Republic of the) Congo (the) Cook Islands (the) Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic (the) Denmark Djibouti Dominica Dominican Republic (the) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (the) [Malvinas] Faroe Islands (the) Fiji Finland France French Guiana French Polynesia French Southern Territories (the) Gabon Gambia (the) Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (the) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Johnston Island Jordan Kazakhstan Kenya Kiribati Korea (the Democratic People's Republic of) Korea (the Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic (the) Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia (the former Yugoslav Republic of) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands (the) Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Midway Islands Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands (the) New Caledonia New Zealand Nicaragua Niger (the) Nigeria Niue Norfolk Island Northern Mariana Islands (the) Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines (the) Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation (the) Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Southern Rhodesia Spain Sri Lanka Sudan (the) Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan (Province of China) Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands (the) Tuvalu Uganda Ukraine United Arab Emirates (the) United Kingdom United States United States Minor Outlying Islands (the) Upper Volta Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Mobile Phone # * Your Role * Please Select One Business Owner CEO/Executive Director Clinical Director/RN Supervisor Operations Manager Scheduler/Care Coordinator Recruitment Marketing Administrator Consultant or Coach Other Industry * Please Select One Non-Medical Home Care Private Pay Only Non-Medical Home Care Private Pay & Medicaid Non-Medical Home Care Medicaid Only Skilled Home Health Medicare Certified Hospice Veterans Affairs Home Care Pediatric Home Care IntellectualDevelopmental Disability Services Adult Day Care Services Residential Group Homes Assisted Living Facility Home Care Staffing/Registry Franchise Home Care Agency Business Stage * Select the Option That Best Describes Your Stage Researching How to Start In the Process of Launching Under 500 Hours Per Week Between 501 to 1500 Hours Per Week Between 1501 to 3000 Hours Per Week Between 3001 to 6000 Hours Per Week Between 6001–10000 Hours Per Week Above 10000 Hours Per Week Considering Selling or Stepping Away Business Problem * Please Select One Can’t Find or Keep Enough Qualified Caregivers Struggling to Get New Client Referrals Too Involved in Day-to-Day Operations Team Lacks Accountability Agency isn’t Profitable Growth is Limited by Medicaid or VA Constraints Onboarding and Training Systems are Inconsistent Not Sure How to Scale Beyond Where We Are Spending Too Much Time on Compliance Something Else Not Listed Here
