Aligner SCALE Questionnaire

Question Title

* 1. Contact Name:

Question Title

* 2. Contact Title

Question Title

* 3. Contact Phone Number:

Question Title

* 4. Contact Email Address:

Question Title

* 5. DSO Legal Name and/or DBA:

Question Title

* 6. Website:

Question Title

* 7. Aligner Calculator - Average DSO Aligner Lab Fee for Full Comprehensive Treatment?

Question Title

* 8. Aligner Calculator - Are you required to pay the full Aligner Lab Fee upfront?

Yes

No

Question Title

* 9. Aligner Calculator - Average Patient Treatment Fee for Full Comprehensive Aligner Treatment?

Question Title

* 10. Aligner Calculator - Average Patient Down Payment Required?

Question Title

* 11. Aligner Calculator - Average Treatment Time for Aligner Patients?

Question Title

* 12. Aligner Calculator - Do you offer financing option for Aligners?

Yes

No

Question Title

* 13. Aligner Calculator - Average Monthly Payments for Aligner Patients?

Question Title

* 14. Aligner Calculator - Do you offer discount for PIF patients for Aligners?

No

Yes (please specify what percentage)

Question Title

* 15. Aligner Calculator - Average Appointment Intervals for Aligner Patients?

4

6

8

10

12

Other (please specify)

Question Title

* 16. Aligner Calculator - Average Number of Attachments for Aligner Cases?

0

1-5

6-10

10-15

15-20

20+

Question Title

* 17. Aligner Calculator - How many total annual New Patient Ortho Starts for Aligners in PY?

Question Title

* 18. Aligner Calculator - What is your annual goal for New Patient Ortho Starts for Aligners this year?

Question Title

* 19. Aligner Calculator - Other Notes, Needs, & Key Information regarding Clear Aligners.