Individual Investor form

Please complete the information below.

Name

Email

Phone

Location

Profession

If Physician, Nurse or Other Clinician: How many years in practice

Specialty

If Other Clinician: Clinician Type

If Other: Do you have funds available to invest that you do not require to live on at this time?

Yes No

Would this be your first equity investment?

Yes No

Do you prefer to be contacted via phone or email?

Phone Email

What are your best day/times to meet with one of our GHIN Principals?

How did you hear about GHIN?

Select which you are interested in hearing more about.

Individual Investor Form