Tell us about your practice

This takes about 3 minutes. Your answers help us calibrate the assessment to your specific practice and goals.

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Practice Basics

Practice Name

The name that will appear on your report

Practice Zip Code

Helps us benchmark against your region

Practice Website

Optional — helps us understand your market presence

How long have you owned the practice?

years

How old are you?

years old

What practice management software do you use?

This helps us tailor the report upload instructions

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Schedule & Team

Days you work per month

Based on a 4-week month

days / month

Total hygiene days per week?

Count each day a hygienist works as one. Example: 2 hygienists × 4 days = 8

days / week

Do you have an associate?

Yes No

How many days per month does your associate work?

days / month

Associate daily production average

What your associate produces on a typical day

$ / day

I don't know

Your daily production average

What you personally produce on a typical day

$ / day

I don't know

Hygiene daily production average

Average production per hygienist per day

$ / day

I don't know

How many crowns do you average per month?

crowns / month

I don't know

Do you have a daily production goal that's realistic and that your team talks about every day?

Yes No Sort of

As the month goes on, do you know whether you're ahead or behind your goals?

Yes No Sometimes

Operatories currently functioning

ops

Total # of Opps you could expand to

ops

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Practice Management Setup

Are fees attached to each procedure on your scheduler so scheduled production is accurate?

Yes No Not sure

Are your insurance fee schedules current and entered in your PM software?

Yes No Not sure

Are insurance write-offs calculated automatically, or entered manually after the fact?

Automatic Manual Mix Not sure

Are you constantly having to make large write-offs or patient adjustments to balances?

Yes No Not sure

Do you have a system for collecting patient portions (statements, payment plans, collections process)?

Yes No

Do you do dedicated bite/realign consults in a separate appointment, or try to fit them in during hygiene?

Dedicated appointment (Bite Wellness Visit or similar)

Fit into hygiene appointment

We don't do these consults

Not sure

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Goals & Vision

How many more years do you want to work?

This helps us frame recommendations around your timeline

1 – 5 years

5 – 10 years

10 – 15 years

Not on my radar

What are your biggest concerns right now?

Check all that apply

✓I want to be more profitable ✓I want to be busier ✓I want to pay my staff more ✓I want to take home more ✓I want more control over my practice ✓My staff is driving me crazy ✓My overhead is too high ✓Insurance reimbursements are killing me ✓I need more new patients ✓I'm thinking about selling or retiring

How would your life improve if these things were all more manageable or resolved?

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