ExecTech Client - Partner or Associate Questionnaire
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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. How many years have you been with this practice?
2. What is your relationship with the practice or main doctor (if a partner or shareholder, please describe your ownership arrangement)?
3. Do you have a written agreement with the practice?
4. Is there anything you would like changed about this agreement? If so, please explain.
5. What schools did you attend?
6. What degrees have you earned?
7. In which states are you licensed to practice?
8. How long have you been licensed?
9. Which specialities have you mastered?
10. Why did you select this profession?
11. What do like most about your profession?
12. What do you like least about your profession?
13. If you could start over, what, if anything, would you do differently regarding your career choices?
14. Where did you first practice? What problems did you encounter? Why did you leave?
15. Where did you practice next? What problems did you encounter? Why did you leave?
16. Where else have you practiced? What problems did you encounter? Why did you leave?
17. Please describe your working relationship with the main doctor:
18. How could your working relationship with the main doctor improve?
19. Do you supervise any staff members? If so, who?
20. What could improve about your working relationship with the people you supervise?
21. What could improve about your working relationship with all the people in the office?
22. Please use at least three sentences to describe the mood or tone of the office?
23. What do you like or dislike about staff meetings?
24. Of all the people in the practice, who is the most difficult to get along with?
25. Of all the people in the office, who is the easiest to get along with?
26. What is the biggest source of stress in the office?
27. What do patients complain about the most?
28. What is your normal schedule?
29. What schedule would you prefer?
30. If your patient load was to increase by 20%, could you handle the flow without more help? If not, please explain.
31. Could you take on more duties and responsibilities? If so, please explain.
32. If you were assigned more responsibility, would you expect more pay?
33. Are you responsible for attracting some or all of your own new patients?
34. What types of promotional activities do you do?
35. What, if anything, do you do to help collect money for the practice?
36. What, if anything, do you do to help manage the practice?
37. On a scale of 1-10 with 10 being the best, how do you rate your treatment skills?
38. On a scale of 1-10 with 10 being the best, how do you rate your patient communication skills?
39. What percentage of your new patients actually follow your recommendations?
40. To do a better job, what would you like to learn?
41. To do a better job, what must change?
42. What continuing education seminars have you attended recently?
43. Are you satisfied with your pay? If not, please explain.
44. Do you receive any other benefits from this practice? If so, please explain.
45. Is your income higher this year compared to this same time last year?
46. What are the three most important things you want from this practice?
47. What are the three most important things the practice wants from you?
47. What are the three most important things the practice wants from you?
49. What is your spouse's name?
50. What role, if any, does your spouse have in the practice?
51. What were your original goals for working in this practice?
52. Which of these goals have you achieved?
53. What are your goals for the next year?
54. What are your goals for the five years?
55. What are your goals for the 10-20 years?
56. What difficulties will you need to overcome to reach these goals?
57. Of all the problems or difficulties in this practice, which are the highest priority to resolve in your viewpoint?
58. If you were in charge of the practice, what would you change?
59. What experience do you have with management consulting companies?
60. What are the first three problems ExecTech should help resolve?
61. Overall, what do you like the least about working here?
62. Overall, what do you like the most about working here?
63. Do you have any final comments or questions?
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