Survey

1. What percent of your gross revenue are you currently spending on marketing (approximately)

What percent of your gross revenue are you currently spending on marketing (approximately) 0%

1% - 2%

3% - 4%

5% - 7%

More than 7%

2. Is your total number of active patients...

Is your total number of active patients... Shrinking

Growing

Staying about the same

3. Is your gross revenue...

Is your gross revenue... Shrinking

Growing

Staying about the same

4. How much would you like to increase your gross revenue over the next year?

How much would you like to increase your gross revenue over the next year? Growth Goal (in dollars)
Optional: What is your current annual gross revenue?

5. What percentage of your patients are NOT fee-for-service? (approximately)

What percentage of your patients are NOT fee-for-service? (approximately) 0%

25%

50%

75%

100%

6. In the practice schedule, roughly how many hours are open (unscheduled) each week?

In the practice schedule, roughly how many hours are open (unscheduled) each week? 1 - 3

4 - 8

9 - 16

17 - 24

25 - 32

More than 32

7. How many of your patients would you say know all the services you can offer them?

How many of your patients would you say know all the services you can offer them? Very few

About half

Most

All

8. Have you noticed that any of your patients have received treatment elsewhere for procedures you provide? If so, which did they get?

Have you noticed that any of your patients have received treatment elsewhere for procedures you provide? If so, which did they get? N/A

Chairside whitening

Veneers

Implants

Crowns

Other (please specify)

9. On average, how often are your patients coming in for hygiene--regardless of what you've scheduled?

On average, how often are your patients coming in for hygiene--regardless of what you've scheduled? 6 months

7 - 9 months

10 - 15 months

More than 15 months

10. What type of marketing are you doing currently?

What type of marketing are you doing currently? Yellow pages

Direct mail

Radio/TV

Internet

Patient newsletters

Referral services

Print advertising

Other (please specify)

11. What percent of your associate's time is unscheduled? (approximately)

What percent of your associate's time is unscheduled? (approximately) No associate

0% - 10%

11% - 25%

26% - 50%

12. What percent of your hygienist's time is unscheduled? (approximately)

What percent of your hygienist's time is unscheduled? (approximately) No hygienist

0% - 10%

11% - 25%

26% - 50%

13. What is your transition / retirement strategy timetable?

What is your transition / retirement strategy timetable? No strategy

1 - 5 years

6 - 10 years

11 - 15 years

More than 15 years

14. Do you have a website?

Do you have a website? No

Yes

If yes, what is the URL? (e.g. www.practicename.com)

15. About how far out are you currently booking new patients?

About how far out are you currently booking new patients? 1 - 5 days

1 - 2 weeks

3 - 4 weeks

1 - 2 months

Not accepting new patients

16. Rate the telephone skills of your receptionist.

Rate the telephone skills of your receptionist. Excellent

Good

Fair

Poor

17. During business hours, do you answer the phone live?

During business hours, do you answer the phone live? Always

Except during lunch

About half the time

We let the answering machine screen our calls

18. How do you feel about emergencies?

How do you feel about emergencies? Love them

Necessary, but not loved

Tolerate them

They are an inconvenience

They are undesirable

19. Rate your case acceptance.

Rate your case acceptance. 30% - 49%

50% - 70%

More than 70%

20. Which best describes the dentistry CURRENTLY done in your practice?

Which best describes the dentistry CURRENTLY done in your practice? 100% restorative

20% cosmetic / 80% restorative

40% cosmetic / 60% restorative

More than 40% cosmetic

21. What would be your IDEAL cosmetic / restorative mix?

What would be your IDEAL cosmetic / restorative mix? 100% restorative

20% cosmetic / 80% restorative

40% cosmetic / 60% restorative

More than 40% cosmetic

22. Which special services do your offer in your practice (select all that apply)?

Which special services do your offer in your practice (select all that apply)? Endo

No-prep veneers

Perio

Ortho

Implants

Laser treatments

Invisible braces

One-visit crowns (CEREC®)

1-hour teeth whitening

Other (please specify)

23. How many hours are you open per week?

How many hours are you open per week? More than 40

35 - 40

30 - 34

Less than 30

24. Approximately how many patients are you currently serving?

Approximately how many patients are you currently serving? 500 or less

501 - 1,000

1,001 - 2,000

More than 2,000

25. Are you open any evenings, weekends or early mornings? (check all that apply)

Are you open any evenings, weekends or early mornings? (check all that apply) N/A

Evenings (after 6 p.m.)

Early mornings

Weekends

Other (please specify)

26. Which best describes the accessibility of your practice? (check all that apply)

Which best describes the accessibility of your practice? (check all that apply) Storefront style (walk-in traffic)

Office building (destination, multi-tenant, no walk-in)

Stand-alone building (destination, no walk-in)

27. How many operatories do you have?

How many operatories do you have? Total # of operatories
# of operatories in schedule

*
28. Please provide your contact information for a comprehensive marketing assessment without charge.

Please provide your contact information for a comprehensive marketing assessment without charge. Name:
Practice Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Cell phone:
Email Address:
Office Phone Number:

29. Name of person completing this survey

Name of person completing this survey Doctor

Other (please specify)

TO COMPLETE YOUR MARKETING SELF-ASSESSMENT, PLEASE CLICK "DONE" BELOW!

1. What percent of your gross revenue are you currently spending on marketing (approximately)

2. Is your total number of active patients...

3. Is your gross revenue...

4. How much would you like to increase your gross revenue over the next year?

5. What percentage of your patients are NOT fee-for-service? (approximately)

6. In the practice schedule, roughly how many hours are open (unscheduled) each week?

7. How many of your patients would you say know all the services you can offer them?

8. Have you noticed that any of your patients have received treatment elsewhere for procedures you provide? If so, which did they get?

9. On average, how often are your patients coming in for hygiene--regardless of what you've scheduled?

10. What type of marketing are you doing currently?

11. What percent of your associate's time is unscheduled? (approximately)

12. What percent of your hygienist's time is unscheduled? (approximately)

13. What is your transition / retirement strategy timetable?

14. Do you have a website?

15. About how far out are you currently booking new patients?

16. Rate the telephone skills of your receptionist.

17. During business hours, do you answer the phone live?

18. How do you feel about emergencies?

19. Rate your case acceptance.

20. Which best describes the dentistry CURRENTLY done in your practice?

21. What would be your IDEAL cosmetic / restorative mix?

22. Which special services do your offer in your practice (select all that apply)?

23. How many hours are you open per week?

24. Approximately how many patients are you currently serving?

25. Are you open any evenings, weekends or early mornings? (check all that apply)

26. Which best describes the accessibility of your practice? (check all that apply)

27. How many operatories do you have?

*28. Please provide your contact information for a comprehensive marketing assessment without charge.

29. Name of person completing this survey

*
28. Please provide your contact information for a comprehensive marketing assessment without charge.