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?