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 production12345

    Getting accounts receivable control (collecting past due monies)12345

    Scheduling for greater profitability and sanity12345

    Transforming staff into team12345

    Improving internal patient flow12345

    Increasing new patients (marketing)12345

    Improving case presentation and treatment acceptance12345

    Having hygiene department be more profitable12345

    Clarifying practice and personal goals12345

    Hiring, training and keeping good staff12345

    Want more time for myself to enjoy life12345

    Funding my children’s education12345

    Getting financial arrangements with patients under control12345

    Funding Retirement12345

    Enhancing Physical Environment12345

    Reducing numbers of days worked each week/year12345

    Improving my business decision making ability12345

    Getting greater control of time12345

    Seeing fewer patients and doing higher quality treatment12345

    Reducing dependence on insurance12345

    Increasing recare system effectiveness12345

    Increasing recare system effectiveness12345

    Getting control over cancelled and broken appointments12345

    Lowering overhead costs12345

    Creating an exit/transition strategy12345

    Achieving economic freedom12345

    Improving leadership skills12345

    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?

    What is 5 x 7 ?