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Name (First and Last)
Practice Name
Address
City, State, Zip
Mobile Phone
Personal E-Mail
Preferred Contact Method Preferred Contact Method Call My Cell Text/SMS E-mail Facebook Messenger Instagram Messenger Other
Website URL
How Did You Hear About Heidi?
Year of dental school graduation?
Have you ever been an associate?
What year did you buy your practice?
Has your practice grown since last year?
How many active patients do you currently have?
What experience do you have with any previous business coaching, consulting, seminars, or guidance? (Describe)
Did you get results from previous training?
Are you reaching your goals? (If not, what are the challenges)
What type of dentistry do you LOVE to do? List what you do outside of general dentistry (Invisible braces, placing implants, sedation dentistry, laser, wisdom teeth extractions, etc.)
Do you have any associates?
How soon can a new patient get in to see you?
How many operatories/dental treatment rooms do you have?
Are all of the operatories set up and available to use?
Do you have ANY open time or unbooked hours in the next 3 weeks of your schedule? (Be sure to notice if appointments are overbooked/dragged down or longer than you need.
Do you have short notice cancellations or no shows?
What is the average number of broken/no-show appointments each week in hygiene?
What is the average number of broken/no-show appointments each week in doctor's chair?
What is your case acceptance rate?
Do you look forward to going to work? (If not, why?)
Do you have team meetings? (If so, what type and how often?)
Do you have low office morale? (If yes, why do you think it is low?)
Have you had employee turnover in the past 2 years?
How many new patients do you gain each month? (Average net)
What percent is your overhead? (Overall and payroll)
How far out is your schedule booked? (Doctor and hygiene)
If you were to list your top 3 challenges, what would they be?
Do you have a retirement plan/goals? Are you on track to meet them?
What days/hours is your practice open?
During office hours, how many hours does a live person not answer the phone?
Do you have a mission, vision, and core values for your practice?
Do you know your "Brand" for the practice? If so, what is it?
Do you have a visible office sign?
Are you in a stand-alone building?
What type of businesses are within 5 miles of your practice?
What are your marketing efforts?
What marketing has worked well or not worked well for you?
Are you using any social media or have an online presence?
What is the last 12 months average monthly production?
What is your average collections for the last three months?
What is your total accounts receivable? (What is in the 0-30 days, 31-60 days, 60-90 days and over 90 days+)
How many dollars are there in outstanding insurance claims?
What is the collection verses production percent?
What percentage of production is done by the hygienist? (Not including exams)
Tell me how many team members and what titles you have right now?
What do your employees do well?
What amenities do you offer your patients?
How many calls per week go out to schedule past-due recare and incomplete treatment?
Do you use software that emails/texts patients? If so, through which company?
Do you send email campaigns and/or newsletters to your patients? (If so, how often?)
Do you use a virtual insurance billing company or outsource any jobs? If so, through which company?
What dental software are you using?
If your previous answer was "other" please enter which software your office utilizes.
Are you currently using a dental consultant/business coach? Would you mind telling me little bit about your experience?
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