Rate Your Practice

Your Name: *
Practice/Company Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone: *
Email: *
Fax:
1. I work in a dental practice with (number of) doctors and (number of) other team members.

For questions 2-9, please rate your perceived success and effectiveness in the areas described from 1-5 per this scale:

0 = Idon't know
1 = very poor/embarrassing
2 = poor
3 = could use improvement, but it's not too bad
4 = it's good
5 = it's great/exemplary
X = not applicable

Rating
2. Teamwork and communication: attitude, expectations, mission statement, goal setting, team meetings
*
3. Scheduling: Handling broken appointments, filling voids
*
4. Financing: patient financing options available and presented, insurance systems in place
*
5. Technology: full use of computers and other dental equipment
*
6. Business tracking and management: overhead control, fee analysis, payables, monitors, accounts receivable control, statements, collection, inventory control, follow-up on treatment diagnosed but left untreated
*
7. Patient relations: new patient experience, treatment case presentations, consultations, patient education
*
8. Dentistry/clinical: quality dentistry and clinical services, treatment planning, efficiency, hygiene retention, periodontal program, sterilization/infection control
*
9. Marketing: telephone skills, welcome packets, website, patient correspondence, advertising
*
10. I feel my teammates would agree with me on the ratings I've given the areas listed in question 2-9.  Yes   No
11. Comments about your practice's current strengths & weaknesses:




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