Getting to Know You Step 1 of 4 - Practice Information25%Doctor(s) NameDoctor Email Have you worked with a dental consultant before?YesNoComments on above questionPractice NamePractice Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Practice Phone-Main LinePractice Phone-Back LineAge of Doctor/OwnerGender of Doctor/OwnerMaleFemaleFrom which dental school did you graduate?What year did you graduate from dental school?How long have you owned this dental practice? Save and Continue LaterDo you still enjoy going to work every day?YesNoComments on above questionDo you have work – life balance?YesNoComments on above questionHow many Dentists work in this practice?012345678910 or moreHow many Associates work in this practice?012345678910 or moreHow many Hygenists work in this practice?012345678910 or moreHow many Dental Assistants work in this practice?012345678910 or moreHow many Dental Registered Dental Assistants work in this practice?012345678910 or moreHow many Dental Business Team members work in this practice?012345678910 or moreHow many Other Team members work in this practice?012345678910 or moreIf you are not currently working with an associate, are you open to the idea?How many locations do you have?012345678910 or moreHow many treatment rooms do you have?What type of dental software do you use in your practice? Dentrix, which version? Eaglesoft, which version? SoftDent Easy Dental Open Dental Other, please specify:What specific areas would you like to see addressed?Team members: Please give a brief description of each team member and their mindset. Examples: goes the extra mile, resistant to change, great attitude, poor attitude, great team player, excellent people skills, helps patients relax, etc. Save and Continue LaterIs the new patient flow adequate to support your goals?YesNoHow many new patients are you seeing per month?How many new patients would you like to see each month?In my mind’s eye – the vision of my ideal practice looks like this:How many days per week do you work now?How many days per week would you like to work?How many new patients per month do you average now?How many vacation weeks per year do you average now?How many vacation weeks per year would you like to average?What is your production per year now?What would you like your production per year to be?What is your collection per year now?What would you like your collection per year to be?Please list the reasons you are interested in an advisor becoming involved in your practice: Save and Continue LaterRate Your PracticeHow would you rank your practice’s performance when it comes to the following key performing elements of your dental business? Scale of 1-10. 1=Poor 10=ExcellentLeadership12345678910Teamwork12345678910Effective Communication (with team and with Patients)12345678910Mission/Vision/Goals – Strategic Planning12345678910Organization Meetings12345678910Financing12345678910Insurance Management12345678910Collections12345678910Scheduling12345678910Overhead Control12345678910Monitoring KPIs12345678910New Patient Growth12345678910New Patient Experience12345678910Case Presentation12345678910Case Acceptance12345678910Maximization of Technology12345678910Clinical Efficiency12345678910Documentation12345678910High-Performing Hygiene12345678910Hygiene Retention12345678910External Marketing12345678910Internal Marketing12345678910Referrals & Reviews123456789105-Star Customer Service12345678910Practice Culture: A Healthy Work Environment12345678910 Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.