Bloom Discovery Form

Bloom Discovery Form
Practice Name
Doctor Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
How did you hear about us?
What are the main goals you want to achieve from hiring Bloom?
We're going to ask you some questions regarding your practice, departments and team. This part takes about 10 - 15 minutes to complete. The more information you can provide us with, the better "Bloom"print we can custom create for you!
How many locations do you have in operation?
How many team members do you currently employ? (Include full time, part time, and remote)
How many Doctors own the practice?
Was the practice purchased from another doctor, or are you a start-up?
Any Associate Doctors on your team?
What practice management software do you use?
Do you utilize any additional apps for team management, communication, or tracking? (Slack, Gaidge, Mondays, Google Calendar, etc)
Do you track case acceptance? If so, what is your average case acceptance percentage?
Do you have an Observation(Obs) or Growth and Development program?
Does your practice utilize the "Same Day Start" or "Same Day Braces" method?
If you have additional comments about your TC systems/sales department, please list them here!
How would you rate your financial team's ability to collect revenue?
Do you collect consistent income month to month?
What are your biggest challenges in your financial/AR department?
Are you "in-network” with any insurance companies? If so, who?
Do you like your current scheduling template? Is there anything you want to change?
Do you utilize procedure codes for your appointments?
How far are you booked out for new patient exams? And how far are you booked out for starts?
Are you satisfied with your welcoming team and the experience your front office team creates for guests?
Do you utilize a new patient intake form or new patient call sheet?
What are some challenges you have with your front desk/front office team?
What percentage of your revenue do you spend on marketing annually?
Who oversees the marketing in your office?
What are some of the biggest marketing challenges that your practice faces?
What are your biggest challenges with your clinical department/clinical team?
Do your clinical systems and clinical team run on time?
How do clinical assistants handle uncomfortable conversations with patients/parents?
Do your clinical team members help "market" your practice during appointments?
Do you utilize an in-house lab, and if yes - what are the goals of your lab?
If you have any additional comments on your clinical team, clinical systems or lab, this is the place for them!
Do you have a management team? If so, who is part of it?
What are some of your biggest management challenges?
Are you satisfied with your clinical outcomes and is there anything you would like to change regarding your treatment systems?
Do you feel well balanced between your home/work life? Would you like to learn how to manage that balance better or differently?
Please list anything else you want us to know here!
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Bloom Discovery Form

We're going to ask you some questions regarding your practice, departments and team. This part takes about 10 - 15 minutes to complete. The more information you can provide us with, the better "Bloom"print we can custom create for you!