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Practice Analysis Form

FIND OUT WHAT OUR CLIENTS ARE SAYING

"I am very pleased at the new direction my practice has taken, and Janet was definitely the catalyst that enabled us to make positive and productive changes."

Gerald L. Chachere, DDS
Opelousas, Louisiana

To get the most from your complementary, no-obligation practice analysis, please answer these questions for a custom-tailored Practice Analysis. Once we have received your analysis, you will receive a no obligation, one hour telephone consultation with Janet Steward, President of Steward Quantum Leap Dental Consulting. If you have any questions or problems with the form, please call 970.207.0776, or e-mail to Steward Quantum Leap.

The data below is for the month ended:

Number of treatment rooms

Average doctor days worked each week

Average hygiene days worked each week

Average number of hygiene appointments each week

Year-to-date production

Accounts receivable balance

Estimated number of patients of record

Estimated number of hygiene appointments scheduled in the next six months

Estimated percentage of patients in periodontal maintenance

Please check yes or no for each of the following questions:	Yes	No

Have you had employee turnover in the last 12 months?
Has your production leveled off or declined?
Do you have openings in the schedule 3 weeks+ out?
Do your patients have to wait 3 weeks+ for an appointment?
Are staff salaries more than 20% of collections?
Are hygiene salaries more than 33% of their production?
Do you find managing your practice challenging?

What are the top one to three areas of biggest concern?


Dentist Name
Practice Name
Address
Email		Telephone
Web URL		Fax