Initial Discovery Questionnaire

Check next to the items that you want to improve. Then rate the importance and urgency of the checked item on a scale of 1 – 5, (1 being the most important/urgent and 5 being the least)

Collecting what is produced 12345
Reducing stress 12345
Increasing doctor’s production 12345
Getting accounts receivable control (collecting past due monies) 12345
Scheduling for greater profitability and sanity 12345
Transforming staff into team 12345
Improving internal patient flow 12345
Increasing new patients (marketing) 12345
Improving case presentation and treatment acceptance 12345
Having hygiene department be more profitable 12345
Clarifying practice and personal goals 12345
Hiring, training and keeping good staff 12345
Want more time for myself to enjoy life 12345
Funding my children’s education 12345
Getting financial arrangements with patients under control 12345
Funding Retirement 12345
Enhancing Physical Environment 12345
Reducing numbers of days worked each week/year 12345
Improving my business decision making ability 12345
Getting greater control of time 12345
Seeing fewer patients and doing higher quality treatment 12345
Reducing dependence on insurance 12345
Increasing recare system effectiveness 12345
Increasing recare system effectiveness 12345
Getting control over cancelled and broken appointments 12345
Lowering overhead costs 12345
Creating an exit/transition strategy 12345
Achieving economic freedom 12345
Improving leadership skills 12345

Putting all considerations such as time and money aside, on a scale of 1 – 10 (10 being the highest), how committed are you to resolving these issues

What is your current work schedule? (write time next to day)

How many staff members are in your practice?

Are you participating in any insurance plans?

YesNo



What is your average new patient number per month?

Where do they generally come from?

Total Collections Goal for Last Year was

Total Collections Goal for This Year is

and Total Collections Goal for Next Year is

Overhead Percentage

Which of the following technologies do you have?

Digital X-RaysCerecDiagnodentTrojanIn-office WhiteningExtra Oral Camera Cosmetic Imaging LaserInvisalign (or similar)Third Party Financing


Have you worked with a consultant in the past?

YesNo

If so, which company or individual?