ExecTech Client - Office Material Questionnaire
Please provide us with the following eight items. If any these items are in digital format (in your computer), please upload them in the appropriate section below. Otherwise, please provide printed copies to your consultant. Ideally submit the form in one sitting. If needed, click "Save Progress" at the bottom of the form, then choose "Skip Create an Account", enter your email address and return to complete at a later time.
Name
*
First Name
Last Name
Position
*
Practice Name
*
1. Monthly production statistics for the past 12 months. If not easily available, then for the past three months.
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2. Copies of fliers, newsletters, postcards or advertisements you use to attract new patients.
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3. Copy of your telephone directory ad (unnecessary if you only have a listing with no ad).
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4. Copy of your fee schedule.
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5. Copies of your patient forms, policies, agreements and brochures that you give to new patients.
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6. Copy of your employee handbook or staff office policy.
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7. Copies of all written agreements with staff, associates or outside contractors.
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8. Copy of your Profit and Loss statement or monthly expenditures OR complete the Financial Spreadsheet form in the Questionnaires section.
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