ExecTech Client - General Questionnaire
Ideally complete the form in one sitting. If you are not able to do so, you can click "Save Progress" at the bottom of the form, then choose "Skip Create an Account", then enter your email address to get your draft form sent to you for finishing later on.
Name
*
First Name
Last Name
Doctor Type (MD, DDS, DO, etc)
*
Practice Name
*
Speciality
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
1. Are you the sole owner of your practice? If not please describe the practice ownership arrangements.
2. Number of years at current location?
3. Do you own or lease the building?
4. If leased, when does your lease expire?
5. Number of square feet?
6. Do you have enough space?
7. Are you happy with your current location?
8. What are the office hours?
9. What is your normal schedule?
10. What schedule would you prefer?
11. What percentage of your time is spent working with patients?
12. What percentage of your time is doing lab work?
13. What percentage of your time is spent working with staff members?
14. What percentage of your time is spent working with staff members?
15. What percentage of your time is spent working on collections?
16. What percentage of your time is spent working on practice promotion?
17. What percentage of your time is spent working on other types of tasks?
18. How many computers do you have in your office?
19. How many of these computers are connected to the Internet?
20. What type of Internet connection do you have in your office?
21. What is your practice website?
22. Are you happy with your practice website?
23. What practice software programs do you use?
24. What office functions do you wish were computerized?
25. Do you use e-mail every day?
26. What tasks do you do with your computer?
27. What tasks do you do on the Internet?
28. Do you consider yourself an experienced computer user?
29. What tasks do you wish you could do with your computer or on the Internet?
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