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.
Name
First Name
Last Name
Preferred First Name:
Office Phone Number
-
Area Code
Phone Number
Mobile Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Year Practice Founded:
Type of Dentistry Performed:
Team Members also attending and their role in the practice:
1. Do you currently have a Health Relationship Coordinator or New Patient Coordinator?
Yes
No
1b. If not, do you plan to develop one of your current team members into that role? Who?
2. Please rank the following desired outcomes in YOUR order of importance:
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:
3. Do you routinely offer New Patient Comprehensive Examinations?
Yes
No
Sometimes
3b. What % of the time?
4. Briefly explain your New Patient Process:
5. 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?
Yes
No
Please upload your current statement.
Browse Files
Cancel
of
When was it last updated?
What your team involved in its creation?
Yes
No
Do you share this statement with your patients?
Yes
No
If so, how is it done?
6. Briefly summarize your assessment of your post graduate technical training:
7. Are you currently enrolled in any ongoing post graduate training or do you intend to be in the next two years?
Yes
No
7b. With which group/center?
8. Other comments you would like our faculty to know:
Submit
Should be Empty: