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The Freedom of Owning Your Own Cash Based Practice with Trent Burchett

Trent Burchett, Owner of Optimize U Physical Therapy & Wellness

Joining us is Dr. Trent Burchett! Trent and I worked together at the end of 2021 and beginning of 2022 to help him get started with his practice. Trent started his own practice after facing the stresses and demands of a clinic. Like so many of the business owners that we've interviewed, once Trent abandoned the "what if" mindset and started his own practice, he discovered freedom. Freedom to make his own schedule, freedom to take side jobs if he wanted, freedom to negotiate for a higher salary! In the end, it has lead to Trent enjoying his work again, enjoying family time, and finding his self-worth.

What we will be covering:

Share a little bit about your story:

Trent: My name is Dr. Trent Burchett. I'm a physical therapist for three years now. I had a little bit of a non-traditional route into PT world. I went the PTA route first and knew I wanted to get a PT degree. I didn't decide to do it right off the bat for some reason, I don't really know why. I went to the University of Findlay and got my PT degree transitional PT there. Right out of school I started working at a small clinic in a place called Vanceburg, Kentucky where I was the sole PT there. Then about three months into that job, my director offered me the opportunity to be the clinical manager. I obviously took that job as soon as I could because I felt like that was the highest I could get. I was satisfied with my career at that point, but I knew I wanted more. I worked in that job for about a 1 1/2 - 2 years and it just got to be too much. That location is about a 40 minute drive from my house. It was difficult driving there, working 10 hour days. I don't know if you've been a clinical manager before. I was the sole PT, so it was just me. I put out all the fires, but I'm also doing 7-9 evaluations a day. At the end of the day, my brain was absolutely fried. My wife was telling me it was a struggle for me to even function in the evenings, so I decided that that wasn't for me.

I switched roles one more time and transitioned to a closer location thinking that would be easier on me, (still as a clinical manager at a bigger facility). It wasn't any easier. Then I decided again that it wasn't for me. I talked with Morgan and I stalked her Facebook page. We talked a couple of times and then I pulled the trigger working with her. It was a great experience! At that point, that's when I decided to open up my business. After we worked together and got me going, it was really just a couple months, we were actually starting to see people and business changes. It was really nice. That's where I'm at now. Now, I have between six to ten patients currently. I'm also in a contract with a wellness provider in the area. He's actually a dentist so it's an interesting story.

Morgan: Oh yeah! Trent has gone on such a journey and we started working together last August. We met one time and then you went to France for a while and then we got back together. It hasn't even been a year Trent.

Trent: Yeah it'll be a year in September (2022) when I filed my LLC.

Morgan: You have traveled a lot. I feel like that's something that has been a little bit unique to you with the different people I've worked with. You took time off which is something that can be kind of difficult to do when you're running your own business. You traveled, you saw friends, and you had a bunch of different opportunities as you were getting set up as well, and you still managed to stay consistent and work on growing your business. That's something that I really admire about you and you're of the process that no matter what else happens, whatever is outside of your control, you can only control what you do. Being able to be decisive and consistent over time as you're growing your practice, you will eventually get there. Great job with all that!

Now you're here with a partial to a full caseload. Can you tell us a little bit more about your particular practice? (Who you work with or who the ideal was, and then who you're working with now).

Trent: Working with Morgan, obviously we tried to niche down as much as possible. In my business plan and model, my focus was to work with back pain patients, active people in the community that deal with back pain, (acute or persistent back pain). That didn't quite work out that way at the beginning. We started working and getting some clients, and for some reason traction built and I was now the postpartum guy. I got one girl that reached out to me and I did more of a wellness programming for her. Then, she recommended me to a couple of her friends, so I built a little group of about four to five postpartum women, still with back pain, but not exactly ideal. It worked out well though. They got good success with working with me and we were able to make them feel a little better and actually feel a little bit more confident in themselves after giving birth. It was actually pretty satisfying to work with them. I got myself a new little niche I guess.

I'm a mobile PT practice, but I also do wellness. I travel to people's homes, offices, I have a foldable table I bring with me. I deal with a cash based service only at this time, and my wellness side of things I do a lot of programming for women with postpartum. I do fitness programming, nutrition programming for them, and guide them along the way if they're dealing with emotional stresses or sleep issues. I'm there to be their contact, to help them get through those difficult times, but also still continue to improve.

Morgan: That's awesome. I think that really reflects well of what to expect when you're first getting started as far as niching down. If you had kept it super broad you wouldn't have gotten to where you are right now. You might go through a few different niches as you're getting going and that's okay. You just have to decide on one, try it, and then if it doesn't work then you can start to look into other things as well.

I know you're mobile now, but also had some experience working in a gym and working out of the dentist office. I was just wondering if you could elaborate on your experiences with the different settings you've worked in?

Trent: Yeah. I probably should mention my business name too. It's called OptimizeU Physical Therapy and Wellness. I did trial some gym opportunity that came available for me to rent a small space, basically big enough to fit my table in. I did an open house and I did end up seeing a couple people there. I got business from that facility. We worked together for about three months or so. I just wasn't getting the traction that I expected to get. I turned my gears more towards the wellness side. At that point it was the 100 Challenge time with Morgan's program which really got me outside of my comfort zone, but it got me my biggest client right now, (and they're a continued client still), with my wellness programming. During the 100 Challenge I reached out to a local dentist office and educated him what I was doing, my goal. He was a younger dentist so he fit the mold and he really enjoyed the the opportunity and what I was trying to do. What I do is I go to his office monthly, usually it's twice a month, and he pays me for wellness services for all of his dental hygienists and all the staff. He uses it as a benefit to his staff which is different than a normal physical therapist or wellness business that you can think of. It works out really well because with those types of jobs, they're prolonged positioning jobs that cause persistent neck and back pain. The girls there really enjoy it and they seem to get a lot of benefit out of it too. I've been there pretty much since we did the 100 Challenge which was I think sometime around October (2021), so it's worked out really well for him.

Morgan: I just think that's so cool and there's something that I want to point out here. I was just talking to one of my other clients and they were asking me about how in a traditional therapy setting you might prescribe somebody their initial plan of care where you meet twice a week for four weeks. Then, in a traditional setting a lot of the time after that initial plan of care is "go ahead, get out of here, you're done". When it comes to being cash based or even just working for yourself, even if you do accept insurance, there are other options for you to keep people around, as long as it's appropriate and if they so choose to stay (we're not forcing them). My other client was asking about that: how do you go about keeping somebody after the initial plan of care and keeping them long term? You have this client that you've been working with for coming up on a year. I've had different clients where I've worked with them on and off for two years even, and they stick around. I'd love to hear more about what you think about that.

Thoughts on keeping someone after the initial plan of care is done/keeping them long term:

Trent: I also have two other clients I've been working with since me and Morgan started too. They're more like PT. We've transitioned them to wellness a while back, but they've been with me since I started as well. At the beginning you're dealing with a big problem. My client in particular had a big back pain issue that she's been dealing with for forever. We got that under control for the most part. She's veterinarian, works really long and inconsistent hours, and really active. She would text me at random times, but I would always check in with her throughout the week because there would be a couple days I wouldn't hear from her for a while. Something would happen at work, she would get kicked by a horse, or she had issues at work because it's such a physically intensive job. What we would do is we put it on hold. I'd create a small program for her to do on her own and when she felt comfortable for us working together again she would always just check in with me along the way. It's like an accountability partner more than anything. I was just there when she needed me. She knew what to do, exercise wise, and then when something got flared up she'd call me and we'd get her right back on the caseload again. It's really staying in contact with that person whether you're working with them or not. Even if it's just monthly checking in, seeing how they're doing, and getting the continued buy-in with that person. It helps build the rapport and keep them in the back of their mind that you're always there if they need to get their back fixed all of a sudden from a horse kick or something crazy like that. Always checking in and being in the back of their mind and knowing that you're there if they need you. I think people really trust and and believe in you when you can do that.

Morgan: I totally agree with you. A couple of things come to mind that I've learned over the past couple of years. One of them being that even though all of us have really limited time, spending the time, and investing the time into somebody who is a good fit and is on the fence, continuing to build a relationship with them until they feel comfortable enough to work with you is huge. You have to change your mindset around it a little bit from, "I want this person to pay me immediately" or start working with them right away. You have to change your mindset from that kind of place of scarcity to, "Eventually, whenever this person feels like it's appropriate they'll tell me, 'Yes, we'll start working together", so I'm going to spend my time and energy getting to know them, making sure that they're comfortable. In the end it will pay off most likely.

You've mentioned wellness a few times and that's one of the biggest questions that a lot of this audience has. What's the difference between wellness and PT?

Trent: I consider the two with my form of business is: wellness clients I pretty much just do programming for basic level exercise and manual techniques. At the dentist's office I consider it wellness. It's not really PT because I'm not treating a specific pain point. I'm just dealing with flexibility, trying to keep their posture upright so that they're not sore and achy at the end of the day. I also for my wellness clients do specific workout programs, focused on their fitness goals.

The PT clients, I consider them having a specific diagnosis that I'm actively treating with manual therapy techniques, (including joint manipulation, massage). It's more skilled involved techniques that would require me to correct them in the exercise process rather than just switching their programming to help build them to be able to do a heavier squat. More of a pain point than a personal goal in my mind. It's kind of a difficult question. They fluctuate between the two for sure.

Morgan: I know that this is a big thing that comes up with regards to Medicare patients and that's not something that I personally have a lot of experience with because my group of people that I work with through PT are under the Medicare age, so it doesn't really come up too much. However, I know that that is a really common question that people have because the lines I think between being a physical therapist who offers wellness services and just somebody on the street who offers wellness services I feel it can get kind of blurry.

I really like the way that you defined it and I think I would agree. That's what I would say too is that physical therapy is a specific pain, a specific injury diagnosis, or helping somebody get from poor quality of life and lack of independence to that point where quality of life is okay at the very least. They're independent, but there are so many other problems that we can help guide people through to the wellness side. Instead of fixing the shoulder pain it's, "let's fix your shoulder pain and then we're also going to work on building strength overhead and address your posture so that it doesn't come back", or because like you said there's a personal goal.

Trent: That was kind of like you were saying you don't deal with Medicare patients as much. I don't really either, but I did have one that was in a scenario where he was actually going to PT at the facility that I did PRN work at while I was opening my business, so it was pretty difficult to keep those two lines separated from each other. What we did was he was in therapy at the facility getting aquatic physical therapy for his back pain. What I worked on was mostly a lot of flexibility work and a lot of manual soft tissue work. Then, I taught him exercise progression. At the at the rehab facility he was at, they were just focusing on getting him some abdominal strengthening and moving in the water because he was in so much pain with his back. I was being the person that was giving him the thing he felt like was benefiting him more by the manual and flexibility and progressing his exercise. The rehab facility (the aquatics treatment) was managing his back pain. I wasn't technically treating his back pain. That was difficult though because I was still working PRN, so we had to separate things. I couldn't do any assessment while I was at the facility so that complicated things. It is doable though, for sure.

Morgan: I know one thing that we had talked about and something I usually suggest for other professionals in that situation is as soon as you're presented with that, or even prior to being presented with an opportunity where it feels like a gray area, write down your company's policies. What therapy is, what medically necessary therapy is versus wellness, fitness, or just health coaching services. Make sure you give specific examples and write it down for yourself. I feel like that is really helpful because you don't have to keep having this discussion with yourself. Look at your exact objective criteria in your practice and then utilizing that and any other sources, like the Medicare website, and documenting the reason why this person is X, Y, or Z. What do you think about that?

Trent: Yeah, you gave me that as a recommendation too when we got started; I think it was with this scenario actually. You said, "Make sure you put it in your intake paperwork: what is PT, what is wellness, so there's a clear line between the two and there's no confusion." If he (my client) were to go bill or try to get reimbursed for my services, things would pop up as a "why are you receiving two physical therapy businesses services?" In my documentation and my intake paperwork it all justifies why it's one or the other. That would take care of that issue if it ever would occur.

Morgan: This is one of the biggest barriers for a lot of therapists getting into their own practice. We all want a very concrete, exact, accurate answer for these questions and sometimes there is one, sometimes there's not. All you can do, through talking to people, writing down, documenting your assessment is, having it backed up by resources, just doing your very educated best to make decisions. That's part of the autonomy that we have as therapists, to make those decisions based on this observation, these facts that I have, this is why this person qualifies for Medicare covered services or not. That's all you can do is your best.

Trent: We all took an exam so we know what's what's expected, and you're supposed to do no harm and do the right thing. We all have ethical and moral reasons why you would choose what to do. As long as you go with your gut most of the time, it's going to be the right decision. That is a difficult scenario at the beginning. I was having trouble with that too, but you giving me the clear lines of one way or the other, that definitely helped a lot for sure. Now I'm not really too worried about it a whole lot anymore.

What have you learned in the past year about all of this (taking the leap of faith to open your own practice, where do I find patients, how am I going to make this work, how to do marketing)?

Trent: It's definitely been a big learning curve for me because I'm not a marketing person. I'm really good with interpersonal skills and social interaction, but when it comes to social media, marketing stuff, that's not for me. My wife has done all that for me and helped me a lot with that whole process and transition. Outside of social media, it's getting in the community as much as you can, talking to people as often as you can. I think you gave me a task one time when I was at the gym to just talk to random people in the job and break gym. Super weird, but I did that and it got me a couple people while I was there. I was getting nothing the whole time I was there and then I tried that and I actually got a couple people out of it. It took me out of my comfort zone for sure, but it definitely worked. They don't know about you if you don't tell them about you is what I learned through the whole process. You tell as many people as possible about what you're doing and they're eventually going to get some kind of interest in what you're doing.

Morgan: Exactly, and I love that. That's where it starts is just by talking to people. Another example that I give is at my home gym that I go and work out at. I don't think either time that I've been in a different CrossFit gym, I didn't start going to that gym with the intention of getting clients in the first six months that I was there. I'm just happy doing my workout and meeting different people. More so at my current gym, as I was meeting people and talking to everybody I would mention that I'm a physical therapist and I have my own practice. That's it. Once you make people aware of who you are and how you can help people, just keep making friends in a relationship. Eventually at both gyms, people started coming up to me and asking if I could help them with something or if they can book an appointment. They have come to know and trust you.

Trent: Yeah like you said, if you come up to people and you say, "I own my own business." They immediately ask what you do and when you tell them you're a physical therapist, the next question is, "How does it work?" I've had that happen hundreds of times since I've opened my business. You say one statement and they lead the questions to where they want to go and you just explain yourself from there. That's how I've done my marketing and social interaction in the community.

Morgan: I think that's awesome. That's really good sales advice in general, on your end of the conversation, don't say more than you need to. Don't try to say, "I have my own private practice, and I practice out of this gym, and my house, and online, and I help people do these things, and it's better because it's cash and..." Word vomit is too much and the person you're talking to will be like "Wow! Bye!"

Trent: For sure. I was definitely guilty of that at the beginning. We had a couple people reach out to me on social media and that was immediately what I did was word vomit everything I knew about my business. I tried to give them all the information.

Morgan: I think that's good advice too. Just hear the question, internalize the question, and answer JUST the question, instead of everything. It's not as hard as you think. I think we make it hard because we want to give all the information, but that's honestly not always what people are looking for. They might come up to you and say, "Hey, I heard you're a PT. Can you fix my shoulder?", and then you'd say yes. Then you can just go forward from there. That's awesome.

Trent: People that are looking for this type of care are not going to be a whim purchase. You're not going to just mention that you have a practice and they're going to pull out their cash and pay you right on the spot. There's no reason to incentivize them to try to speed up the process. It's kind of like a slow burn, Answer their question, it causes some of them to get a little bit intrigued, they start processing.

I've had people reach back out to me two weeks after I made contact with them in person and ask for me to tell them a little more about something. Then you answer their question and you may not sell them until a month later. That's how this process works with this type of a business. It's not a go to Walmart, walk through the store, and then you saw something on the shelf you weren't ready for and you buy it anyway.

Morgan: I think that's a good way to look at it. For me it's electronics, but I do a lot of research on electronics, watch reviews, and look it up. Then I go to the store and buy.

Trent: Yeah, that's a big ticket purchase. $20 is nothing compared to you spending $1,000 on a plan of care with someone. You're definitely going to do your research and learn as much as possible about that person before you say "I'll buy that", unless you depend on working with millionaires or something.

Morgan: I think that's happened to me one time that I can remember where I told somebody, "It's going to be $1,500 for this plan of care", and I was panicking on the inside saying that. Then the patient I was with was just like "Okay, do you take credit?"

I think that leads into another little thing that I've talked everybody's ear off about. When it comes to finances and worrying about if somebody is going to pay for your services, you can't assume anything. Then you end up making yourself spiral about if they going to be able to afford the eval or the plan of care, what if they don't like it, what if they don't see the value in it. My biggest advice on that has always been don't assume anything about the other person. Typically when people want some kind of result they'll figure out a way to find the money for it. What do you think?

Trent: Definitely, I would say that's true. I had this girl. She was 26 years old and she had three kids, she was actually a speech therapist in the school system. She didn't have a lot of money. When I reached out to her, I was kind of surprised that she was okay, but at the beginning it wasn't that simple. We had to explain the process of everything, but we realized that she had a FSA card. She had been saving money in that FSA account and never really used it or knew what to use it on, so I told her that's what this is for. She had no problem paying for it at that point because she never utilized that account and didn't know what to do with it. It gave her a different way to purchase what she was actually looking for.

Morgan: That's something to note for anybody reading this. Lots of people have HSA and FSA cards that they don't really know what it is, but those cards we can accept as a medical practice. The policies, I assume and believe, for those types of accounts will vary depending on who the cards are through. For most of the clients that we will work with, they can use those cards to pay for our services and they might have a few grand in there that they're not going to use on anything else. That's always something to ask about.

It can be scary to leave a full-time job, so tell us a little bit more about your experience with that.

Trent: Yeah, like I said at the very beginning, I was a full-time PT and I was actually a clinical manager at the time too. I was over 10 therapists at the facility I was working at. I thought I was at the top and doing what I could, knowing in the back of my mind that the only step up for me was a Clinical Director. I knew I didn't want to go non-clinical completely, it wasn't in the cards for me. That was a bit difficult because I had the stability of a steady paycheck, but my mental health and my time freedom was just in a dumpster. I had no energy to do anything. I used to be really into working out, it slowed me down from working out because I didn't have the energy to do anything at the end of the day.

It was definitely a difficult transition though because of the stability factor. However, I took the chance because I wanted more time and freedom. That's what it brought me to. I have the opportunity to make more money than I've ever made as a clinical manager now than I did when I was working full-time, which is crazy to think about. It's created opportunities for me to take other positions that I would not elsewhere been able to. I'm an adjunct professor at a DPT school as well. I teach three classes in the Fall. I would have never been able to do that and get that experience. I love it, it's so much fun. I can also, if I want, can pick up some PRN gigs if I'm slow. That's what I've done. You can make extra cash in that way. I am really lucky that my wife works a full-time job and she stays at home with her job. She has really good health insurance with it so I don't have to deal with losing insurance and all that stuff. I was lucky in that sense, so that helped me to be able to do it.

I knew in the back of my mind if something were to happen I could always go back to that job. I could always get another full-time job if I wanted it. You helped me realize that too at the beginning when we did our first free consultation call. There's always going to be a position for you somewhere might as well take the chance. This is this is your time, so I did it and I don't regret it.

Morgan: I don't know if I've ever met anybody with a practice that says that they regret it.

Trent: It's a blast and really fun. I mean I can make my own schedule. I can work when I want. You can't ask for anything better.

Morgan: I've been trying to get my husband to move on to PRN/see his own clients because he has one right now, but he's always so worried about whether he's going to have enough PTO to go and see his family. He's used up a lot of it this year with different things that we've done, and I know that something that stresses him out. Even when he's sick, he has to use PTO for the first three days before his sick days kick in, so he's always so stressed out about missing work. When you work for yourself, as long as everything's relatively planned out, you can decide when you want to take time off. You can even take a sick day if you don't feel good, and your clients will understand. That I think has been huge and something that at times I feel I've kind of taken for granted, but it really is a huge benefit to working for yourself.

I also just wanted to point out too the other cool thing with being in charge of your professional work and not having to do a 9 - 5 is you've created multiple streams of income too. Sometimes one will be paying more than the other one, but as you spread things out over a few different places, you won't have to depend on only just one thing which is really nice too.

Trent: It gave me the opportunity to have negotiating power in those positions. We were talking before, I just got the opportunity with one of my old clinical instructors. They offered some extra work with a skilled nursing facility. I never thought I would ever work in skilled nursing, my focus is outpatient Orthopedics and sports, but I had negotiating power in that sense because I had my business. I had time and I knew how much I was worth because I found that out by working with you and getting my all my numbers straight. I'm also working at a PRN position where I can say yes or no whenever I want to, so I got negotiating power in that sense. I got way higher hourly rate than I expected to out of that position and it was only because I had this already set in place. I wouldn't have been able to do that otherwise. I would have to turn that money down.

Morgan: Yeah, because at this time they need you more than you need them.

Trent: Right, I didn't care if they said no. That's the thing, I threw an astronomical number out and they said no so I said, "Okay. Sorry I can't help." Then a week later I got a text that said they were able to negotiate with their regional director and they were going to be able to do that salary I had requested. Now, I give them a couple hours a week on Friday morning so I can make a couple of extra 100 bucks real quick. It doesn't take that much time away from my business and I can still do what I want with my family on Fridays when I take the Friday off.

Morgan: It really does teach you to value the education that you have and the skills that you have. Now I value that part of myself a lot more than when I was working an outpatient Ortho. That's not only just clinically. Being able to take away somebody's pain is the coolest thing ever, but by going through this process of growing a business, you learn so many more of the ins and outs of it that when it comes to negotiations or other opportunities you don't have to say yes to them out of desperation. You can go into that conversation with a lot more knowledge about what you bring to the table.

Trent: As a new grad PT coming out of school if somebody threw $40 on the table for me I was like, "Yes!" Now that's that's nothing. I mean there's no way I would take a job for $40 an hour. I would probably laugh if somebody offered me $40 an hour, just knowing what I can make and what I'm worth. I'm able to charge for people and they see the worth in me when I'm able to help them. (Top)

What is the biggest mindset change that you've had in the past year?

Trent: The biggest thing for me I would say is getting to know people through personal interaction and social media and marketing. That was difficult for me at the beginning and it was a big, difficult learning curve for me because I'm not used to throwing myself out there. Doing it once or twice and exposing yourself to it, after that it's not a big deal. You learn small skills that. Now I have the confidence to do it anytime I want to. If I want to get some extra clients I can always just beef up my social media videos or have my wife help me with some social media content and get that stuff out there. That helped a lot being able to do that and know those skills now.

What advice would you give somebody who is going to be a new practice/business owner new business owner?

Trent: I would definitely say do it for sure! Do it and then figure out the stuff as you go because that's really what I was worried about. I was super nervous when I first started, thinking, "What am I going to do with my money, my insurance, and all this stuff? What if it fails". You and my wife were both like, "So what if you fail? Who cares?" That was a big mindset shift for me too, just realizing that if it failed, it failed. It's not the end of the world and I can always go do some something else.

Morgan: I love that. There's so many positives that'll come out of it and even the negatives: the fear, the worry, the anxiety of "am I going to make enough money?" You figure it out. Whether you succeed in the way that you thought you would or you figure out that maybe this isn't for you, that's okay. At least you tried it and it's not a regret that you have down the road.

Trent: It's a lot likePT school. You stress and worry, and then you take a clinical practical exam and it's the most stress you've ever had in your entire life. Then after you do one, it's not that bad at all and then the rest are really not that bad. That's kind of how it. Once you have the exposure to those stresses one time, you pull the Band-Aid off, it's never going to be that bad again.

Morgan: Except maybe for for practicals, so much drama. Thinking about it now, I'm sure that all of the professors that we had were all looking for bare minimum competency doing those things, but I would get so worked up about all of them, going to take somebody's blood pressure.

Trent: Now being on the other side where I'm adjuncting for a for a PT school, I get to see all those stresses show up in students. That's honestly what I tell them at the beginning, "We're just making sure that you don't injure someone; the bare minimum to get by. Don't stress about it." Because it's a stressful situation, but then afterwards they come up to me going, "Did I fail? Did I fail?" No, you're fine, you passed. Then you can just see the relief. It's wild, but I kind of relate the business worlds to that. You're just constantly treading water trying to stay above, but in a good way.

Morgan: You have to remember that everybody who looks really successful on the outside was once where you were or are. Even our professors in the clinicals. They had to do those at some point too. Nobody is going to look at you and think that you're dumb for starting a business.

I think I've only ever received positive support. Just go for it. It'll be fine.

Trent: My mom always used to say, "Everybody puts their pants on one leg at a time." It's the same process. At one point everybody was starting out and now they're successful. All you see is a success. You don't see all the difficult struggles that they went through to get there.

How to contact Trent:

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