PM3A Application

1
Full Name* This field is required.
First Name
Middle Name
Last Name
2
Email Address* This field is required.This should be a personal email address where Dr Buttar can reach you (all info is confidential and will NEVER be shared with anyone)
Email Verified
Email Verified
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3
Phone Number* This field is required.This should be a personal cell number where Dr Buttar can text you (all info is confidential and will NEVER be shared with anyone)
4
Current Address* This field is required.This should be an address where you can receive mail (all info is confidential and will NEVER be shared with anyone else)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
What doctorate degree do you hold?* This field is required.The PM3A is open to any physician or independent health care provider that is licensed or able to get a license (DO, MD, DDS, DMD, DPM, DC, ND, NMD, or equivalent). Please indicate your degree.
MD/DO (or equivalent if from outside the US)
ND/NMD (or equivalent if from outside the US)
DDS/DMD (or equivalent if from outside the US)
DPM (or equivalent if from outside the US)
DC (or equivalent if from outside the US)
Other (a health care provider other than listed above)
6
Are you already registered as a Health Care Provider on the Advanced Medicine Platform (www.AdvancedMedicine.com)?* This field is required.All Health Care Providers can have a "Provider" account on the Advanced Medicine website, allowing them to see all the AHEAD Map® Scores of all their patients/clients. There is no cost to Providers for this service.
YESNO
7
Are you a member of the IADFW? (www.AdvancedMedicine.com)?* This field is required.IADFW is an acronym for the "International Association for a Disease Free World"
YESNO
8
If you answered YES to the question above, please enter your Advanced Medicine "Invitation Code" below.Your "Invitation Code" can be found on the upper right hand corner of your Advanced Medicine Dashboard when you are logged in, below your name, in yellow.
9
Are you a member of TAP™ into Reality Mindset Program (www.TAPin2Reality.com)?* This field is required.
YESNO
10
If you answered YES to the question above, please enter your TAP™ ID below.All TAP™ Members are issued a TAP™ ID. If you are a TAP™ Member and do NOT know your ID, contact support at info@advancedmedicine.info and request your TAP™ ID number. Certain information will have to be provided to validate if you are a TAP™ Member.
11
The PM3A (Physician's Medical Master Mind Alliance) P2M2C Group will be open to any physicians or health care providers from anywhere on the planet. However, from this group, only 100 positions (two in each state) in the US and a few additional limited number of positions in other countries will be selected to participate in a new, disruptive insurance program which will revolutionize the health insurance industry. Details will be provided later but speciality, training, and type of practice do not matter. These doctors will by default, achieve extraordinary growth professionally, personally and financially. Explain why you feel Dr. Buttar should select YOU to be among this exclusive and selective group of Doctors?* This field is required.This is an opportunity for you to explain what your long term vision is, and why you should be selected.
Huge
Large
Normal
Small
Ok
Ok
12
If there was a true and proven written plan, with over a quarter of a century and a success rate of 87.6% in reducing symptoms in 6 months or less, regardless of the underlying disease, desired goal or outcome, what would that detailed Medical Manifesto be worth to you? What would you be willing to pay for something this powerful to help your patients and your practice grow beyond the current levels of performance? What is YOUR practice, your professional success, and your personal life worth to you?* This field is required.
Greater than a MILLION!
$1,000,000.00
$500,000.00
$100,000.00
$50,000.00
$10,000.00
$5,000.00
$1,000.00
$500.00
INVALUABLE
13
What level of impact do the following have on your PROFESSIONAL goals as a physician/health care provider and your overall ability to achieve those goals?* This field is required.Please only select 1 option per row
Big Problem
An Issue
Not An Issue
Advantage
Blessing
Time
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Money
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Mobility
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Knowledge
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Fear
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Judgment
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Love
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Spouse
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Time
Money
Mobility
Knowledge
Fear
Judgment
Love
Spouse
Big Problem
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An Issue
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Not An Issue
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Advantage
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Blessing
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Big Problem
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An Issue
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Not An Issue
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Advantage
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Blessing
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Big Problem
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An Issue
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Not An Issue
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Advantage
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Blessing
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Big Problem
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An Issue
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Not An Issue
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Advantage
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Blessing
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Big Problem
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An Issue
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Not An Issue
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Advantage
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Blessing
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Big Problem
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An Issue
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Not An Issue
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Advantage
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Blessing
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Big Problem
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Blessing
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Big Problem
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An Issue
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Blessing
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What level of impact do the following have on your PERSONAL ABILITY to achieve your desired results in life?* This field is required.Please only select 1 option per row
Big Problem
An Issue
Not An Issue
Advantage
Blessing
Training/Experience
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Open mindedness
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Personal Conflicts
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Peers/Acceptance
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Personal Integrity
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Preconceptions
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Family/Children
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Regulations/Boards
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Row 7, Column 4
Training/Experience
Open mindedness
Personal Conflicts
Peers/Acceptance
Personal Integrity
Preconceptions
Family/Children
Regulations/Boards
Big Problem
Row 0, Column 0
An Issue
Row 0, Column 1
Not An Issue
Row 0, Column 2
Advantage
Row 0, Column 3
Blessing
Row 0, Column 4
Big Problem
Row 1, Column 0
An Issue
Row 1, Column 1
Not An Issue
Row 1, Column 2
Advantage
Row 1, Column 3
Blessing
Row 1, Column 4
Big Problem
Row 2, Column 0
An Issue
Row 2, Column 1
Not An Issue
Row 2, Column 2
Advantage
Row 2, Column 3
Blessing
Row 2, Column 4
Big Problem
Row 3, Column 0
An Issue
Row 3, Column 1
Not An Issue
Row 3, Column 2
Advantage
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Blessing
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Big Problem
Row 4, Column 0
An Issue
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Not An Issue
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Advantage
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Blessing
Row 4, Column 4
Big Problem
Row 5, Column 0
An Issue
Row 5, Column 1
Not An Issue
Row 5, Column 2
Advantage
Row 5, Column 3
Blessing
Row 5, Column 4
Big Problem
Row 6, Column 0
An Issue
Row 6, Column 1
Not An Issue
Row 6, Column 2
Advantage
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Blessing
Row 6, Column 4
Big Problem
Row 7, Column 0
An Issue
Row 7, Column 1
Not An Issue
Row 7, Column 2
Advantage
Row 7, Column 3
Blessing
Row 7, Column 4
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15
Select the option that best fits you* This field is required.(If we were to ask your best friend, how would they describe you)
Once I have the knowledge and am pointed in the right direction, I am a machine and follow through on everything. I would consider myself as an optimistic action taker
I am pretty good at follow through but only regarding the things I am convinced about. I have to first be convinced. I would consider myself to be a pessimistic action taker
I need to know and understand everything before I make a decision to move forward. I am NOT a control freak but I have been called that before. I would consider myself to be a guarded optimist
I know most of the info out there and know what I want. I hold back because I don't want to be taken advantage off or make a mistake. I would consider myself to be intelligently cautious.
16
Please choose 1 from the following 5 reasons why you want to join the PM3A (Physician's Medical Master Mind Alliance) P2M2C Group.* This field is required.
- I want the BEST chance to grow professionally
- I want the BEST option to network with like-minded doctors
- I want the BEST financial opportunities available to physicians
- I am curious and want to see what this program is about
- I am only interested in knowing what the program costs
17
Please choose which of the following descriptions fits you the most accurately.* This field is required.More than one of these options may be applicable to you. Please choose the one that fits you most accurately.
- I'm a new doctor looking to start my career in medicine
- I'm looking for a new opportunity to pursue in medicine
- I want the BEST option to grow my existing medical practice
- I'm looking to reduce my own time seeing patients but interested in adding revenue to my practice.
- I am ready to retire but still would like to have some involvement with patients/clients.
18
Upload Video FileThere are many people who want to join one of Dr. Buttar's P2M2C Groups. Although this step is not required for the Physician's Medical Master Mind Alliance (PM3A), many of the people accepted into any of the P2M2C Group have submitted a short video expressing their desire to join. If you so choose, you can simply record a video no longer than 90 seconds, explaining why you feel you are a good candidate for the Physician's Medical Master Mind Alliance (a Pareto Principle Master Mind Consulting Group). Or, you can just bypass this step and hit submit in the lower right hand corner.
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