Dental Practice Audit

Welcome! As we embark on this journey together, we kindly ask for your detailed responses to the following questions. This crucial step helps us better understand your practice, enabling us to formulate effective strategies tailored to your growth. This should be filled out with the practice owner's information and answers. 

Please rest assured that your information is of utmost importance to us. All the details you provide will be kept strictly confidential and will only be used by your dedicated consultant for the purpose of enhancing your business. Your trust and privacy are paramount to us.

Email *
Your Name? *
Practice Name?
Practice Phone Number?
What is the best number to reach you?
Practice website?
How many dentists work in your practice?
Do you have hygienists? If so, how many?
How many staff members do you employ in your practice?
Can you share your current production figures? (Rough estimate)
Can you share your current collection figures? (Rough estimate)
Are you a fee-for-service practice or an in-network provider?
What insurances do you take in-network?
How many active patients do you have?
How many new patients do you receive each month?
What is the average value of a patient to your practice? (You can calculate this by dividing your end-of-year production by the number of active patients)
-How many inactive patients do you currently have?
Do you have an in-house dental plan?
Have you invested in a Practice Analysis at any point?
What are your current marketing strategies?
How much are you currently spending on marketing?
How do you track the effectiveness of your marketing efforts? Do you use any key performance indicators (KPIs)?
What procedures do you enjoy doing the most?
Do you offer tooth whitening?
Do you offer Invisalign or another clear retainer product?
What are your growth goals for your dental practice?
What obstacles or pain points are preventing you from achieving those goals?
Are there any employees or partners who may be holding you back from achieving your goals?
What is the ultimate vision for your practice?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Gizoom Marketing & Consulting. Report Abuse