Pre-NPE Workshop Doctor Survey
The completion of the following confidential survey helps our faculty understand where you are today in your continuing journey toward excellence.
Preferred First Name:
Office Phone Number
Mobile Phone Number
Street Address Line 2
State / Province
Postal / Zip Code
Year Practice Founded:
Type of Dentistry Performed:
Team Members also attending and their role in the practice:
Do you currently have a Health Relationship Coordinator or New Patient Coordinator?
If not, do you plan to develop one of your current team members into that role? Who?
Please list the most important desired outcomes from this workshop for the Doctor:
Please list the most important desired outcomes from this workshop for the Team:
Do you routinely offer New Patient Comprehensive Examinations?
What % of the time?
Briefly explain your New Patient Process:
How well is your current process working? How do you measure that success?
What is working well?
What is not working as well as you'd like? Why?
Does your practice have a written Vision/Mission/Philosophy statement?
Please upload your current statement.
When was it last updated?
What your team involved in its creation?
Do you share this statement with your patients?
If so, how is it done?
Briefly summarize your assessment of your post graduate technical training:
Are you currently enrolled in any ongoing post graduate training or do you intend to be in the next two years?
With which group/center?
Other comments you would like our faculty to know:
Should be Empty: