Free Dental Practice Management Consultation

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The Biggest Problem in a Dental Practice? Find out here:

A FREE 30 minute no obligation Practice Management Consultation is available to you by phone. Simply fill out the form as follows:

+	(Plus) YES
M	(Middle) NOT SURE
-	(Minus) NO

Be one of the first ten respondents for the week and

receive a FREE Dental Office Manual of your choice!

Available to the practice owner only.

1. Is your schedule unpredictable?

+	M	-

2. Is collections at least 98%?

+	M	-

3. Do your staff know exactly how to do their jobs?

+	M	-

4. Do confirmed patients still break their appointments?

+	M	-

5. Are you on track to meet your personal financial goals?

+	M	-

6. Has production plateaued or declined?

+	M	-

7. Are there staff conflicts?

+	M	-

8. Have you lost good staff recently?

+	M	-

9. Do you have time to train your staff?

+	M	-

10. Do you have an effective internal marketing program?

+	M	-

11. Is your percent of payroll over 27%?

+	M	-

12. Is staff morale high?

+	M	-

13. Does the relationship with your staff need improvement?

+	M	-

14. Are you an effective leader?

+	M	-

15. Are you too "nice a guy or gal" with your staff?

+	M	-

16. Are you burnt out?

+	M	-

17. Do you feel you need more new patients?

+	M	-

18. Is your retirement secure?

+	M	-

19. Is it rare for you to get a complaint from a patient?

+	M	-

20. Do you have slumps in income?

+	M	-

21. Are you in control of your practice?

+	M	-

22. Do you enjoy going to work?

+	M	-

23. What goals do you have for your practice?

24. What if anything needs the most improvement in the practice?

25. What if anything is the biggest area of stress in the practice?

This questionnaire will be used in conjunction with your free 30 minute phone consultation.

Your personal information will only be used for your consultation and will be kept strictly confidential.

Due to large number of responses we do not call offices or leave messages with the front desk. We only contact you by cell or home number to schedule.

First Name:
Last Name:
Are you the owner or spouse?	Yes No
State (US):
Email
Cell Phone:
Home Phone:
Best day and time to contact you to schedule your free 30 minute consultation:

Dr. Douglas Snyder, DDS • Indiana

Dr. Eric Forte, DDS • New Jersey

Dr. Doug Voiers, DDS • Ohio

Dr. Chris Rowland, DDS • Tennessee

Dr. Paul Barlow, DDS • Utah

Sahira Lopez, Office Manager • Florida

Toll Free (800) 595-2380

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