Consulting Pre-Visit Questionnaire

Question Title

* Practice Name

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* Your Name

First Name

Last Name

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* Your Role in the Practice

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* What types of marketing does your Practice do for orthodontics?

Internal Marketing to our patients

Radio

Print (Newspaper, magazine, etc.)

Social Media

Google Ads

Mailers

Live Events

None of the above

Website

Other (please specify)

Question Title

* How effective to do feel your current orthodontic marketing is?

Not at all effective

Somewhat effective

Very effective

N/A (no marketing currently)

Not at all effective

Somewhat effective

Very effective

N/A (no marketing currently)

Question Title

* How do you think your marketing could improve?

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* How well do you feel your orthodontic consultations go?

Not very well

Needs improvement

Just OK

Good

Excellent and smooth

Not very well

Needs improvement

Just OK

Good

Excellent and smooth

Question Title

* What is your approximate percentage of consultations that move forward with treatment?

100%

Clear

i We adjusted the number you entered based on the slider’s scale.

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* What would need to be true to make consultations go more smoothly, and have a higher acceptance of treatment?

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* How clinically confident are you in orthodontics?

Not confident at all

Very little clinical confidence

Moderate clinical confidence

Somewhat clinically confident

Very confident clinically

Not confident at all

Very little clinical confidence

Moderate clinical confidence

Somewhat clinically confident

Very confident clinically

Question Title

* Have you taken any orthodontic CE courses?

No, I haven't taken any orthodontic CE

Invisalign series

Powerprox series

COS Implementation Seminars

MTM training

Six Month Smiles training

Comprehensive Ortho Continuum

Other (please specify)

Question Title

* What areas do you feel that training is needed to improve your clinical confidence?

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* Where are the bottlenecks in your current daily patient schedule?

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* Do you have daily or hourly production goals?

Yes

I'm not sure

Question Title

* Practice Name

Question Title

* Your Name

Question Title

* Your Role in the Practice

Question Title

* What types of marketing does your Practice do for orthodontics?

Question Title

* How effective to do feel your current orthodontic marketing is?

Question Title

* How do you think your marketing could improve?

Question Title

* How well do you feel your orthodontic consultations go?

Question Title

* What is your approximate percentage of consultations that move forward with treatment?

Question Title

* What would need to be true to make consultations go more smoothly, and have a higher acceptance of treatment?

Question Title

* How clinically confident are you in orthodontics?

Question Title

* Have you taken any orthodontic CE courses?

Question Title

* What areas do you feel that training is needed to improve your clinical confidence?

Question Title

* Where are the bottlenecks in your current daily patient schedule?

Question Title

* Do you have daily or hourly production goals?

Question Title

* What is one key result you would like to see after COS Consulting visits your Practice?