HSO Partner Questionnaire Question Title * 1. Contact Name: (Required.) Question Title * 2. Contact Title (Required.) Question Title * 3. Contact Phone Number: (Required.) Question Title * 4. Contact Email Address: (Required.) Question Title * 5. DSO Legal Name and/or DBA: (Required.) Question Title * 6. Website: (Required.) Question Title * 7. Total Number of Locations? (Required.) Question Title * 8. Total Number of States group has Locations? (Required.) Question Title * 9. Total Number of Locations doing Orthodontics? (Required.) Question Title * 10. Number of Orthodontists (Specialists) doing Ortho? (Required.) Question Title * 11. Number of General Dentists (GP's) doing Ortho? Question Title * 12. How many total annual New Patient Ortho Starts for Braces in PY? (Required.) Question Title * 13. How many total annual New Patient Ortho Starts for Aligners in PY? Question Title * 14. What is your annual goal for New Patient Ortho Starts for Braces this year? (Required.) Question Title * 15. What is your annual goal for New Patient Ortho Starts for Aligners this year? (Required.) Question Title * 16. DSO Primary Contact(s): (Required.) Question Title * 17. DSO Purchasing Mgr(s): Question Title * 18. DSO KOL Doctor(s): Question Title * 19. Primary Bracket/Band/Wire Ortho Supplier(s): (Required.) Question Title * 20. Current Price Per Metal Bracket? Question Title * 21. Current Price per Clear Bracket? Question Title * 22. Current Cost Per Patient (CPP) for Ortho Supplies? Question Title * 23. Do all doctors in this DSO currently use same line of brackets/bands? (Required.) Yes No Question Title * 24. Primary Clear Aligner Supplier(s): (Required.) Question Title * 25. Current Aligner Lab Fee for FULL Comprehensive Treatment: Question Title * 26. Average Patient Down Payment Required for Aligners: Question Title * 27. Is DSO required to pay full aligner lab fee upfront? Question Title * 28. Does DSO use HenrySchein.com for general purchases? (Required.) Yes No Question Title * 29. Is DSO interested in our new One Schein ordering system that would allow all HSO products to be ordered via their current Schein system with consolidated invoices for general and ortho? (Required.) Yes No Question Title * 30. Does DSO have Central Purchasing System (PO) with Purchasing Mgr for review and approval of orders? (Required.) Yes No Question Title * 31. Does DSO have any reporting requirements on spend? (Required.) Yes No Question Title * 32. Does DSO actively track Ortho supply budgets per location? (Required.) Yes No Question Title * 33. Does DSO want to provide clinical CE support for Ortho doctors and/or staff? (Required.) Yes No Question Title * 34. Does DSO want to provide operational CE support for Ortho TC's and management on case acceptance and KPI's to drive higher conversion rates and top line growth? (Required.) Yes No Question Title * 35. Does DSO want support with Ortho assistant training using our Trapezio partner program? (Required.) Yes No Question Title * 36. Does DSO want doctor recruiting support by using our exclusive Ortho Job Match program with orthodontic residents across the country? (Required.) Yes No Question Title * 37. Does DSO have SOP's in place for Ortho instrument care, inventory mgmt, class II/III correction and/or DENOVO orders? (Required.) Yes No Question Title * 38. Is growing Ortho business within the DSO a focus? (Required.) Yes No Question Title * 39. Is DSO interested in our new Sagittal First workflow solution for orthodontics to help reduce treatment times, increase case acceptance, and enable same-day-starts across all locations? (Required.) Yes No Question Title * 40. Is a Growth Rebate program for Ortho important? (Required.) Yes No Question Title * 41. Is a Price Lock Protection agreement (PVA) important? (Required.) Yes No Question Title * 42. Other Notes, Needs, and Key Information: Done
