Fraud Risk Assessment
Are you at risk?

Welcome! If you’re here you might be looking for ways to take your dental practice is at risk for fraud or embezzlement. No matter the results - we are glad you’re here. Your future success is determined by the steps you take today – that’s where we want to help.

Please complete the Fraud Risk Assessment below. Each section represents an important element for creating the results you are wanting.


After taking the assessment, we will contact you for the next step!
Sign in to Google to save your progress. Learn more
Name *
Email *
Phone
Adjustments For My Practice Are Less Than 10% Of Total Production. *
Disagree
Agree
Cash Deposits Have Stayed Consistent Or Have Risen Recently. *
Disagree
Agree
Patients Hardly Have Questions About Their Account. *
Disagree
Agree
Deposits Always Match With My Practice Management System And The Bank Deposits. *
Disagree
Agree
We Have A Petty Cash Worksheet And Track This Regularly. *
Disagree
Agree
All Of My Employees Are Rule Followers. No One Likes To Bend Or Break The Rules. *
Disagree
Agree
Employees Periodically Take Time Off And Utilize Their Vacation Time. *
Disagree
Agree
The Doctor/Owner Of The Practice Checks References For All New Employees. *
Disagree
Agree
We Have An Employee Dishonesty Insurance Policy In Place. *
Disagree
Agree
Bank And Credit Card Statements Are Balanced With The Practice Management System Deposits Every Month. *
Disagree
Agree
We have secure passwords in place for our computer and practice management system. *
Disagree
Agree
There is not a signature stamp in my office. *
Disagree
Agree
The doctor/owner of the practice checks references for all new employees. *
Disagree
Agree
We have an employee dishonesty insurance policy in place. *
Disagree
Agree
Bank and credit card statements are balanced with the practice management system deposits every month. *
Disagree
Agree
I am ready to discover what I need to do to protect my practice. *
Disagree
Agree
I am open to investing in the support and guidance I need to make my business more secure. *
Disagree
Agree
I highly value the offer of a complimentary Risk Assessment Consultation and, if eligible, will book one soon. *
Disagree
Agree
Please select the option that best describes you *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Global Team Solutions.

Does this form look suspicious? Report