Practice Viability Assessment Form

1
Unique ID
2
Please read these quick and simple instructions:

Make sure you understand and answer each question: You must complete the test to learn your results!

Don't stay too long with one question. Answer as soon as you understand the question and go on to the next one.

Give your answer for how things are for you right now.

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3
Full Name* This field is required.
First Name
Last Name
4
Email* This field is required.
5
Phone* This field is required.
Please enter a valid phone number.
6
Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Company Name* This field is required.
8
My business planning usually has direct and successful results* This field is required.
Yes
No
Not sure
9
I have already incorporated in my practice at least one more innovative service in addition to my physical therapy services* This field is required.
Yes
No
Not sure
10
We are experiencing cash flow problems* This field is required.
Yes
No
Not sure
11
I have a clear plan on handling competition in my area* This field is required.
Yes
No
Not sure
12
There are a few people involved with my practice who I honestly don't feel I can help* This field is required.
Yes
No
Not sure
13
I'm frequently asked for solutions to things that my staff should be able to handle* This field is required.
Yes
No
Not sure
14
I would be ok with my practice staying more or less the same size* This field is required.
Yes
No
Not sure
15
I worry about the debt load of the business* This field is required.
Yes
No
Not sure
16
The number of hospitals, physicians or other physical therapists has increased in my area* This field is required.
Yes
No
Not sure
17
My practice has a good reputation for being clinically and organizationally helpful* This field is required.
Yes
No
Not sure
18
I constantly feel disorganized and like I am always coping to keep things going* This field is required.
Yes
No
Not sure
19
Our marketing is strategic and usually works* This field is required.
Yes
No
Not sure
20
Making a profit is stressful* This field is required.
Yes
No
Not sure
21
I am searching for innovative approaches to help me conquer competition in my area* This field is required.
Yes
No
Not sure
22
There are many people I feel I have failed to help* This field is required.
Yes
No
Not sure
23
Controlling people is a weak spot for me* This field is required.
Yes
No
Not sure
24
We have a written marketing plan* This field is required.
Yes
No
Not sure
25
Major debts or legal situations are looming and worry me* This field is required.
Yes
No
Not sure
26
My competition attracts staff more easily than my business does* This field is required.
Yes
No
Not sure
27
Most people who offer help actually only want something for themselves* This field is required.
Yes
No
Not sure
28
Things tend to fall apart around my practice if I am not there getting involved in everything* This field is required.
Yes
No
Not sure
29
We'd be in deep trouble if a key referral source cut us out* This field is required.
Yes
No
Not sure
30
Salary increases affect the profitability of my business* This field is required.
Yes
No
Not sure
31
I have completed at least one activity that showcases my practice ahead of the competition in my area* This field is required.
Yes
No
Not sure
32
I'd rather just do something myself than teach someone else to do it* This field is required.
Yes
No
Not sure
33
Some of my staff don't understand how their positions affect others in the practice* This field is required.
Yes
No
Not sure
34
I have difficulty finding new staff to hire* This field is required.
Yes
No
Not sure
35
I am happy with insurance reimbursements* This field is required.
Yes
No
Not sure
36
I know exactly what sets me apart from my competition* This field is required.
Yes
No
Not sure
37
I feel like there are one or more members on my staff team who prefer to keep to themselves and don't like to help out much* This field is required.
Yes
No
Not sure
38
I have at least 3 different business sources of income* This field is required.
Yes
No
Not sure
39
I have a frequent turnaround of clinical and administrative staff* This field is required.
Yes
No
Not sure
40
Insurances pay the true value of my services* This field is required.
Yes
No
Not sure
41
Some of my existing client base is threatened by my competitors* This field is required.
Yes
No
Not sure
42
I am seeking help to further grow and establish my practice* This field is required.
Yes
No
Not sure
43
I constantly find myself or my staff piling up with incomplete or half-finished tasks* This field is required.
Yes
No
Not sure
44
My staff are happy with their jobs and it shows in how they interact with each other and with patients* This field is required.
Yes
No
Not sure
45
Declining reimbursements affect my profits* This field is required.
Yes
No
Not sure
46
My business is expanding enough that I do not feel worried about other physical therapy practices in my area* This field is required.
Yes
No
Not sure
47
I am open to learning something new that could help me and my practice* This field is required.
Yes
No
Not sure
Should be Empty: