Please be completely honest when filling out this Practice Analysis questionnaire so that you can get a better idea where you stand and we can fairly evaluate areas where we will be able to make suggestions to help you.

1. What is the average production per month?
less than $20K
$21-40K
$41-60K
$61-80K
$81-100K
more than 100K

2. How many new patients do you average per month?
don't know
10 or less
11-20
21-30
31-40
more than 40

3. Which of the following marketing practices does your office use? (Check each one in use)
yellow pages
newspaper/magazine
practice newsletter or brochure
website
radio and/or television
community projects
patient mailings (birthday cards, etc.)
asking existing patients for referrals
none of the above

4. What is your collection ratio to production?
don't know
less than 80%
81-86%
87-92%
92-97%
more than 98%

5. What percentage of your collections is allocated for expenses?
don't know
more than 70%
60-69%
51-59%
less than 50%

6. What percentage of your expenses is for gross salaries?
don't know
over 35%
30-34%
25-29%
24% or less

7. What is your over 90-day accounts receivable?
don't know
more than $50K
$40-50K
$21-40K
less than $20K

8. What percentages of your new patients have a comprehensive exam on the first visit?
don't know
less than 30%
30-40%
40-50%
51-60%
more than 60%

9. What happens on the first visit?
comprehensive exam
full month set of x-rays and/or panoramic x-ray
bitewings
models
prophy

10. What percentage of the time are treatment plan presentations and financial arrangements made with patients?
0-16%
17-33%
34-50%
51-67%
68-83%
84% or more

11. What percentages of treatment plans are accepted?
don't know
less than 20%
21-40%
41-60%
61-80%
81% or more

12. Which of the following payment options do you offer your patients?
credit card
finance companies
dental payment plan companies
banks
discount for pre-payment in full of treatment plan

13. What percentage of your emergency patients return for complete treatment?
don't know
10-25%
26-40%
41-55%
more than 55%

14. What percentage of your practice is dedicated to cosmetic dentistry?
don't know
less than 10%
11-30%
31-50%
more than 50%

15. How booked is your hygiene schedule on a daily basis?
less than 60%
61-70%
71-80%
81-90%
91% or better

16. How many root canals do you perform per month?
less than 5
6-10
11-15
16-20
21-25
more than 25

17. How many units of crown and bridge do you perform per month?
don't know
less than 10
10-25
26-40
41-55
more than 55

18. How many units of removable prosthetics do you perform per month?
don't know
1-10
11-20
21-30
more than 30

19. What percentage of your denture/partial denture patients opt for implants?
less than 10%
11-30%
31-50%
more than 50%

20. Check only the questions that you can answer "YES" to.
is your practice managed by a formal operating system?
do you monitor production, collections, and/or the number of new patients?
has your production leveled off or declined?
are your accounts receivable higher than 1x your monthly production?
are less than 45% of the monies collected per day being paid at the time of patient dismissal?
do you have empty treatment rooms and unfilled appointment slots in the schedule?
do patients have to wait more than 3 weeks to get an appointment?
do you see too many emergency patients per day?
are you working during your lunch hour?
does your staff frequently get out past regular closing time?
do you monitor treatment presented?
does every patient re-appoint before leaving the office?
is there an appointment policy in place?
do recall patients have to wait past their due date for an appointment?
is your patient retention less than 95%?
is there a formal soft tissue management system in place?
is your hygiene production less than 33% of total practice production?
is less than 33% of your hygiene production for perio treatment?
are hygiene salaries more than 33% of their production?
do you perform medical history updates at every appointment?
do your team members have clear job descriptions with accountability?
is it difficult for you to train your scheduling/financial coordinators?
do you have an employee handbook or policy/procedure manual?
do you worry about when to give raises, how to hire, fire and give performance reviews?
have you had excessive employee turnover in the past 18 months?
do you use an intraoral camera and/or imaging system in your practice?
are you discouraged by not receiving the profit you feel you deserve?

Additional information as necessary

Doctor's Name*:

Telephone Number*:

Email*:

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